CHICKENPOX

Chicken pox, a common infection in children caused by a virus known as varicella-zoster virus. It is a highly contagious disease that spread from person to person causing the infected person to develop fever and a blister like rash. The rash crops up first on the face and trunk and can spread over the entire body. It can be transmitted through the air when someone with chicken pox sneezing or coughing or by touching the watery stuff that comes out from the chicken pox blisters.

Symptoms of chickenpox

1. Fever
2. Loss of appetite
3. Tiredness
4. Headache
5. Rash starting as small, itchy red spots like pimples all over the body including the mouth

Chicken pox infection generally will results in lifelong immunity. But the virus may remain hidden and reactivate as shingles in a proportion of adults and sometimes children.

SHINGLES

Shingles is an acute infection caused by the herpes zoster virus, the same virus as causes chickenpox. Shingles occurs because of exposure to chickenpox or reactivation of the herpes zoster virus. The virus remains latent (dormant) in nerve roots for many years following chickenpox. Thus, shingles only happens in people who already had chicken pox. Usually adults age ≥ 50yo will be affected.

Symptoms

1. Pain in the affected nerve area, ranging from a tingling sensation to very severe burning pain that indicating nerve damage.
2. Mild fever
3. Tiredness
4. Unilateral, localized rash that become blisters

DIFFERENCES OF CHICKENPOX AND SHINGLES

How is chicken pox and shingles being treated?  

General:

• Keep the infected child at home (about 7 days from the onset of rash).
• Drink plenty of water to prevent dehydration.
• Take analgesic (eg.paracetamol, mefenamic acid, diclofenac) for fever or to  reduce pain.
• Stay cool and wear loose-fitting clothes, preferably made of cotton.
• Take balanced meals
• Keeps hands clean

For itchiness:

• Apply cooling gel or calamine lotion on the rash.
• Keep fingernails short and clean to prevent scratching and possible scarring.
• Use a cool compress to soothe the itch
• Antihistamine medications (eg. Cetirizine, loratadine or chlorpheniramine) may be prescribed if the itch is very bad.

Antiviral medication to slow down the progression and stop the growth of virus. Example : acyclovir, famicyclovir , valacyclovir. It is usually prescribed for those at risk for severe disease, such as:

• Those older than 12 years old.
• Those with chronic lung disease/skin disease.
• Those on long term salicylate therapy (like aspirin).
• Those receiving short, intermittent, or aerosolized course of steroid therapy.
• Some groups of pregnant mother.

Antiviral topical treatment to speed up the healing of the sores and decrease the symptoms (like tingling, pain, burning or itching).

• Apply the antiviral cream 6 times per day for at least 5 days to stop the growth of virus.
• Apply the cream onto the affected area and rub in gently. Make sure the cream is enough to cover all affected area.
• Apply to skin only. Do not apply this medication in the eyes or nose, inside the mouth, or inside the vagina.                                                           

SUPPLEMENTS

Multivitamin and mineral

A high-potency multivitamin and mineral supplement may help to protect against cell damage. Look for a supplement with all the key ingredients, including vitamins C, E and selenium for antioxidant support. Vitamin B12 may help to support the formation of  myelin (a layer that cover the nerves). Keeping the myelin sheath healthy may even make the reactivation of the virus – which causes the symptoms of shingles – less likely.

Lysine

Lysine play an important role in the immune system. Combined supplement of lysine and zinc may help to reduce infection in people with compromised immune system. Lysine is also important for the body’s production of collagen, a protein that’s essential for healthy skin.

Probiotic

Probiotics are made of good live bacteria and/or yeasts that naturally live in our body. When you get an infection, there is more bad bacteria knocking the system out of balance. Good bacteria then works to fight off the extra bad bacteria and restore the balance within the body. Therefore, probiotic supplements are a way to add good bacteria to the body, supporting the immune system and controlling inflammation.

References

1. Morgan, C. and Slater, O., n.d. Chickenpox and Shingles. [online] Natures Best. Available at: <https://www.naturesbest.co.uk/pharmacy/pharmacy-health-library/chickenpox-and-shingles/> [Accessed 20 June 2021].
2. PORTAL MyHEALTH. 2012. Chickenpox – PORTAL MyHEALTH. [online] Available at: <http://www.myhealth.gov.my/en/chickenpox/> [Accessed 4 July 2021].
3. PORTAL MyHEALTH. 2017. Varicella-Zoster Viral Infection – PORTAL MyHEALTH. [online] Available at: <http://www.myhealth.gov.my/en/varicella-zoster-viral-infection/> [Accessed 5 July 2021].

COVID-19 has been existing for more than one and half years now. At the outset of COVID-19 pandemic, the symptoms and the risks of it had been emphasized from time to time to all the citizens. However, new variants of coronavirus are always out there as these coronaviruses are constantly changing themselves rapidly through a process known as mutation.

The cycle of mutation will occur continuously leading to the emergence of new variants. As these viruses change, they will become more diverse and the symptoms if infected will be changed as well. A major concern right now in our country is the highly transmissible and fast-spreading Delta variant. Delta variant was first documented in India in October 2020. Delta variant is believed to be up to 60% more contagious compared to the Alpha variant and it will become the dominant variant of the coronavirus soon. It was first identified in Malaysia in early July 2021 and has led to another wave of COVID-19 here. This Delta variant may cause a higher hospitalization rate and more severe complications to humans. The incubation period will be shortened to 3 to 7 days compared to 2 weeks in the Alpha variant. Delta variant usually attacks the elderlies and people with weakened immune response. Infection caused by Delta variant will progress quickly leading to severe cases in just 3 to 4 days. Some might even be admitted into the ICU in 24 hours. The Delta variant is so much more contagious as it has higher viral load, it is better at infecting people who are not sufficiently immuned. Delta variant is transmitting at a very high speed with a ratio of 1:4, meaning that 1 infected person might spread the viruses to 4 persons and so on in the same space, same unit or even same building. In order to break the chain of transmission, ones should practice social distancing at a distance of at least 2.5m.

Comparison Among Different Coronavirus Variants
There are 4 main variants of coronaviruses around the world right now which are Alpha (B.1.17), Beta (B.1.35), Gamma (P.1) and Delta (B.1.617) variants. The following shows some differences among these strains of virus:

Figure 2: Differences Among Alpha, Beta, Gamma and Delta Variant

 Common Symptoms Caused by Delta Variant

The symptoms of COVID-19 will evolve in pace with the evolution of the virus strains. Other than the usual symptoms like fever and cough, there are some additional symptoms of the Delta variant that we need to pay attention at such as:

Effectiveness of Vaccines on Delta Variant        
Vaccination appears to show some benefits against Delta variant, even though there is less protection provided by the vaccine compared to other variants of coronaviruses. The following data show the efficacy rates of the vaccine against the symptomatic infections caused by Delta variant by some studies.

Furthermore, vaccinated people are less likely to get hospitalized against Delta variant. The efficacy rates against hospitalization are showed below:

The best way to combat the Delta surge is still the vaccination as fully vaccinated people are having lower risk to be threatened by Delta variant. However, new variants will continue to appear as long as there are large number of unvaccinated people around the world and a new version of the Delta variant, known as Delta Plus is already circulating in other part of the world. If this Delta Plus abroad our country, the unvaccinated communities in our country remain at risk of getting infection.

Reference:
1. The symptoms of the Delta variant appear to differ from traditional COVID symptoms. Here’s what to look out for [Internet]. The Conversation. 2021 [cited 17 July 2021]. Available from: https://theconversation.com/the-symptoms-of-the-delta-variant-appear-to-differ-from-traditional-covid-symptoms-heres-what-to-look-out-for-163487

2. Jay Hilotin S, Shyam A. Krishna S, Alex Abraham S, Seyyed Llata S. Alpha, Beta, Gamma, Delta COVID-19 variants: How dangerous? [Internet]. Gulfnews.com. 2021 [cited 17 July 2021]. Available from: https://gulfnews.com/special-reports/alpha-beta-gamma-delta-covid-19-variants-how-dangerous-1.1624872935207

3. How effective are coronavirus vaccines against the Delta variant? [Internet]. Ft.com. 2021 [cited 17 July 2021]. Available from: https://www.ft.com/content/5a24d39a-a702-40d2-876d-b12a524dc9a5

4. Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. 2021 [cited 17 July 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/variant.html

5. How effective are COVID-19 vaccines against the Delta variant? [Internet]. Los Angeles Times. 2021 [cited 17 July 2021]. Available from: https://www.latimes.com/science/story/2021-07-02/how-well-do-covid-19-vaccines-cover-the-delta-variant

6. Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile | NEJM [Internet]. New England Journal of Medicine. 2021 [cited 17 July 2021]. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa2107715?fbclid=IwAR0ITkADdmafRq8Bx_ce33cDrA72htAxooODiEd6dhFXf1WDyCQw1qoK3O8

As the science and technology become more and more developed nowadays, people are unable to live without digital devices like smartphones, laptops etc. Even students are also using smartphone, tablets or laptops for online classes, especially during COVID-19 pandemic, which has increased the exposure to digital devices. The usage of these digital devices has become a huge part of modern life.

But, do you know that, looking at these digital devices for many hours per day can actually cause a significant stress to your eyes and eventually develop into an eye disease. This is known as digital eye strains. This has increased the threat of digital eye strain (DES), making it an emerging public health problem.

Digital eye strains (DES) which also known as computer vision syndrome is defined by American Optometric Association, includes a range of visual and ocular symptoms occurred due to prolonged use of digital devices. Many studies suggest that the following factors are associated with DES, such as:

• screen glare (reflection from the digital display),
• poor lighting from the room or extensively exposure of lighting from the digital display,
• viewing digital screen from a wrong angle or distance,
• uncorrected vision problem (presbyopia, astigmatism, farsightedness),
• smaller font size

Viewing a digital screen for a few hours or more a day, or being too close to the digital device screen or having eye problems but did not correct with glasses or contact lenses, all these can worsen DES or causing recurrent of DES.

The symptoms of DES include eye dryness, eye fatigue, eye discomfort, eye redness, eye itching, blurred vision and headaches etc. The severity of visual symptoms of DES is based on the level of visual abilities and the amount of time spent on looking on the digital screen. Certain visual symptoms are temporary and will go away after the person stop using the digital devices, but some individual may still experience visual symptoms like blurred vision even after stop using digital devices. Symptoms may get worse if no steps taken to resolve the problem.

Treatments maybe vary for DES, but the symptoms can be relieved through optimal eye care and making changes in how the digital screen is viewed. Treatments include:

• After 2 hours of usage of digital devices, rest your eyes for at least 15 minutes
• Every 20 minutes, look into the distance at least 20 feet away from the computer or digital device. Do this for at least 20 seconds.
• Font size used in digital device should be enlarged.
• Digital devices should be positioned in a way to avoid glare, particularly from lighting of the room or lighting from windows.
• Digital devices should be viewed with the eyes looking downward. The digital screens are best to viewed at a 15 to 20 degrees below eye level and a distance of 20 to 28 inches from the screen (about an armlength)
• Remember to blink your eyes more frequently in order to minimize the risk of developing dry eyes when using a digital device as blinking can keep moisture on the eye’s surfaces.

Besides the changes which were stated above, management of eye dryness can help to treat or prevent the recurrent of DES due to dry eyes. For example, the use of lubricating eye drops to relieve the symptom of dry eyes. Lubricating eye drops can help to relieve symptoms of dry eyes, watery eyes or tired eyes, but it cannot completely cure DES, so only use eye drops when the symptoms are persistent. Some studies suggested dietary supplements such as omega-3 fatty acids and bilberry extract can help in relieving the symptoms of DES. These supplements have an important role in preserving the moisture levels in dry eyes conditions.

In conclusion, prevention is the most important step in management of DES. It involves the ensuring of an ergonomic work environment and practice as well as visual examination and eye care to treat visual disorders. Regular visual examinations can help to prevent or reduce the development of DES.

References

1. Chaitra Jayadey, Puja Sarbajan, and Anand Vinekar (2020 Nov) Impact of the COVID-19 pandemic on digital eye strain in children. Indian Journal of Ophthalmology. 68(11): 2383-2384.
2. Gammoh Y (February 26, 2021) Digital Eye Strain and Its Risk Factors Among a University Student Population in Jordan: A Cross-Sectional Study. Cureus 13(2): e13575. doi:10.7759/cureus.13575
3. Pratyusha Ganne, Shaista Najeeb, Ganne Chaitanya, Aditya Sharma, and Nagesha C Krishnappa (2021) Digital Eye Strain Epidemic amid COVID-19 Pamdemic- A cross-sectional Survey. OPHTHALMIC EPIDEMIOLOGY 2021, VOL. 28, NO. 4, 285–292 https://doi.org/10.1080/09286586.2020.1862243
4. Association AO. Computer vision syndrome. Accessed October 14 2020; Available from: https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y
5. Mark Rosenfield (Jan 2016) Computer vision syndrome (a.k.a. digital eye strain). Optometry in Practice 2016 Volume 17, Issue 1, 1–10
6. Chantal Coles-Brennan, Anna Sulley and, Graeme Young. (2019) Management of digital eye strain. Clinical and Experimental Optometry 2019 ;102: 18-29

Erectile dysfunction (ED) refers to the inability to get or keep an erection firm enough to have sexual intercourse. Erectile dysfunction is usually caused by low blood flow to the penis or problem with the nerves that control erections. Having trouble erecting for short period of time is not necessarily a cause for concern but it can cause stress, affect your self-confidence and contribute to relationship problems if it becomes an ongoing issue.

What are the symptoms of erectile dysfunction (ED)?

The symptoms include persistent:

• Trouble getting an erection
• Trouble keeping an erection
• Reduced sexual desire

What causes erectile dysfunction (ED)?

Problems getting or keeping an erection can be due to various risk factors, including:

• Vascular diseases (such as atherosclerosis which means hardening of arteries): These conditions narrow the blood vessels and reduce blood flow to the penis.
• Neurological disorders (such as multiple sclerosis which is a chronic disease affecting the brain and spinal cord): Nerves that send impulses to the penis can become damaged from stroke, diabetes, or other causes.
• Psychological states: These include stress, depression, lack of stimulus from the brain as well as performance anxiety.
• Trauma: An injury could contribute to symptoms of ED.
• Chronic illness, certain medications, and operations for the prostate, bladder, and colon cancer may also be contributing factors.

How is erectile dysfunction (ED) treated?

• Get More Exercise

Regular physical activity improves blood circulation and decreases the risk of heart disease, diabetes, and obesity, all of which can have an impact on sexual function.

• Stop Smoking

Smoking affects circulation in ways that can inhibit blood flow to the penis and affect the ability to achieve or sustain an erection. Besides, smoking cessation has many other health benefits, such as reducing heart disease and diabetes which are the two major causes of ED.

• Eat Well

The risk of ED can be reduced in people who always eat diets that rich in whole-grain foods, vegetables, and fruits and low in red meat, full-fat dairy products, and sugary foods and drinks have a reduced risk of ED.

• Prescription Medications

The oral medications for erectile dysfunction enhance the effects of nitric oxide which is a natural chemical your body produces to relaxes muscles in the penis. This increases blood flow and lead to erection in response to sexual stimulation.

For Viagra, Levitra, and Stendra—eating a high-fat meal may delay the absorption of the drug, which will prolong the time for erection and diminish the drug’s overall effectiveness.

• Testosterone Replacement Therapy

A healthcare provider may prescribe testosterone replacement therapy if a man is found to have a low testosterone level, along with other symptoms, such as low libido and ED. That said, testosterone deficiency is uncommonly the primary cause of ED. Before you take testosterone, your healthcare provider will have you tested to make sure that you do indeed have a deficiency.

• Reviewing Current Medications

It is very possible that one or more of current list of medications may be causing or contributing to your erectile dysfunction. Medications that classically cause erectile dysfunction as a side effect are antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline). Other potential medications linked to erectile dysfunction include certain blood pressure medications and pain medications.

• Pumps and Implants

A mechanical device may be worth trying if medications and other interventions don’t work.

One option is a vacuum pump, a plastic tube that is placed over the penis. When air is sucked out of the tube it creates pressure that causes blood to be forced into the penis. A ring can then be temporarily placed at the base of the penis to stop the blood from draining away too quickly.

A penile implant is another option. There are two types of penile implant. The first type is called a semi-rigid penis implant, it keeps the penis erect all the time, though it can be bent downward when you aren’t having sex. The other type is an inflatable two- or three-piece penis implant, it includes a pump that’s implanted in the scrotum and can be squeezed in order to make the penis erect.

• Natural Remedies

Research has found that certain natural remedies can improve ED to some extent. Here is a guide of herbs and supplements that may help improve the symptoms of erectile dysfunction:

References:

1. Michael Bihari, MD (2021) Causes and Risk Factors of Erectile Dysfunction.
   Available at: https://www.verywellhealth.com/erectile-dysfunction-causes-and-risk-factors-1124108
2. Alana Biggers (2019) Everything You Need to Know About Erectile Dysfunction (ED).
   Available at: https://www.healthline.com/health/erectile-dysfunction#_noHeaderPrefixedContent
3. US Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases (2019) Erectile Dysfunction.
   Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts
4. Borrelli F, et al(2018) Herbal dietary supplements for erectile dysfunction: A systematic review and meta-analysis.
   Available at: doi:10.1007/s40265-018-0897-3.
5. U.S. Food and Drug Administration (2018) ‘All natural’ alternatives for erectile dysfunction: A risky proposition.
   Available at: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm465024.htm.

In general, fatty liver disease is a medical condition in which fat builds up in the liver. There are two main types of fatty liver disease: (a) non-alcoholic fatty liver (b) alcoholic fatty liver disease.

• Non-alcoholic fatty liver disease (NAFLD) is a type of fatty liver disease that is not related to heavy alcohol use.
• Alcoholic fatty liver disease is another type of fatty liver disease which is due to heavy alcohol use. The harmful substances which are generated during the alcohol breaking process may accumulate and damage liver cells. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease.

According to researchers, the cause of non-alcoholic fatty liver disease is unknown, but this condition is more common in people who:

• Have type 2 diabetes
• Obesity with a high level of belly fat
• Are Hispanic or Asian
• Are middle aged or older
• Have high levels of fats in blood, such as cholesterol and triglycerides
• Have high blood pressure
• Have rapid weight loss
• Have certain metabolic disorders, including metabolic syndrome
• Take certain drugs, such as corticosteroids and some cancer drugs
• Have certain infections, such as hepatitis C
• Have been exposed to some toxins

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time.

SYMPTOMS

Fatty liver disease is usually a silent disease with few or no symptoms until the disease progresses to cirrhosis of the liver. If you do have symptoms, they may include:

• Abdominal pain or a feeling of fullness in the upper right side of the abdomen
• Nausea or weight loss
• Jaundice
• Swollen abdomen and legs (oedema)
• Tiredness and weakness

HOW IS FATTY LIVER DISEASE DIAGNOSED?

Laboratory abnormalities are often the only sign of non-alcoholic fatty liver disease. The most common abnormal laboratory test results are elevated alanine transaminase (ALT) and aspartate transaminase (AST). There are other methods to diagnose fatty liver disease, doctor may order:

• Ultrasound or CT scan to get a picture of the liver
• Liver biopsy to determine how far advanced liver disease has progressed

TREATMENT OF FATTY LIVER DISEASE

There is no medication specifically for fatty liver disease. Instead, doctors focus on helping the patient to control factors that contribute to the condition.  Treatment includes:

• Avoiding alcohol for alcoholic fatty liver disease
• Losing weight for non-alcoholic fatty liver disease.
• Avoiding certain medicine that may cause NAFLD
• Taking medications to control diabetes, cholesterol and triglycerides
• Taking vitamin E and thiazolidinediones (drugs used to treat diabetes) in specific instances, but more studies are needed to support this.

PREVENTION OF FATTY LIVER DISEASE

The best way to avoid fatty liver disease is to do the things that maintain overall health:

• Stay at a healthy weight.
• Exercise regularly
• Limit or reduce alcohol consumption
• Take medication as prescribed

SUPPLEMENTS

Dandelion

Dandelion root contains high amounts of a substance called kynurenic acid, which is an amino acid that is the key for bile production. Researchers found that dandelion is amongst a group of healing herbs that can be highly beneficial for the gallbladder that can improve bile flow.

Dandelion also supports the liver by providing first-layer support for blood detoxification. It’s a great preventative for jaundice, gentle support for those who have hepatitis, and can also help with anaemia since it can encourage iron absorption. Another way that dandelion cleanses blood is by working with pancreas to remove excess sugars. So, dandelion is not only beneficial for liver detoxification, it can balance blood glucose level as well.

Flavonoids in dandelion promote increased urination, which can assist the liver in cleansing toxins out of the body at a more rapid rate.

Dandelion helps the liver to break down and absorb minerals. This is due to dandelion is a great source of vitamin A, B, C, E, K and key minerals, including calcium and potassium. Vitamin C is an important liver helper because it can assist in the breakdown of key minerals like iron.

Milk thistle

Milk thistle is an anti-fibrotic, which means it protects against tissue scarring. Thus, milk thistle can be used to combat liver damage and inflammation caused by acetaminophen, alcohol, chemotherapy and carcinogens.

Milk thistle has the powder to stimulate healing in the liver and protect it from future damage.

When the liver become too overloaded with toxins like heavy metals and pollutants, milk thistle supports the liver’s detoxification process. Milk thistle helps the liver effectively purify the blood, remove harmful substances from the body, produce hormones, and perform countless other essential responsibilities.

Artichoke

Contains a compound called luteolin, which is a potent antioxidant that prevents the synthesis of cholesterol.

The metabolism of cholesterol can be increased by consuming artichoke extract. Thus, it encourages the cholesterol breakdown and elimination. The overall effect is reducing levels of bad cholesterol (LDL) and increases levels of good cholesterol (HDL) in the body.

REFERENCE

1. Topics, H., 2022. Fatty Liver Disease | MedlinePlus. [online] Medlineplus.gov. Available at: <https://medlineplus.gov/fattyliverdisease.html> [Accessed 11 January 2022].
2. Cleveland Clinic. 2022. Fatty Liver Disease: Risk Factors, Symptoms, Types & Prevention. [online] Available at: <https://my.clevelandclinic.org/health/diseases/15831-fatty-liver-disease> [Accessed 11 January 2022].
3. Panahi Y, Kianpour P, Mohtashami R, Atkin SL, Butler AE, Jafari R, Badeli R, Sahebkar A. Efficacy of artichoke leaf extract in non-alcoholic fatty liver disease: A pilot double-blind randomized controlled trial. Phytother Res. 2018 Jul;32(7):1382-1387. doi: 10.1002/ptr.6073. Epub 2018 Mar 9. PMID: 29520889.
4. Wirngo, F. E., Lambert, M. N., & Jeppesen, P. B. (2016). The Physiological Effects of Dandelion (Taraxacum Officinale) in Type 2 Diabetes. The review of diabetic studies : RDS, 13(2-3), 113–131. https://doi.org/10.1900/RDS.2016.13.113
5. Jacobs BP, Dennehy C, Ramirez G, Sapp J, Lawrence VA. Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Am J Med. 2002 Oct 15;113(6):506-15. doi: 10.1016/s0002-93

Intermittent fasting is a dietary approach that involves interspacing planned periods of fasting with regular eating. It is an eating pattern that cycle between periods of eating and    fasting. It focuses more on when to eat rather than what to eat.

Intermittent fasting works by prolonging the period when the body has burned through the calories consumed from the last meal and begins to burn fat. The body will use up its sugar stores and starts to burn fat after hours of fasting, this process is known as metabolic switching.

Benefits of Intermittent Fasting

Help Lose Weight and Visceral Fat

Intermittent fasting can support hormone function to facilitate weight loss. Lower insulin levels, higher Human Growth Hormone (HGH) levels, and increased amounts of noradrenaline can assist in the breakdown of body fat and facilitate its use for energy. Because of this, fasting actually increases the body metabolic rate and eventually help to burn more calories. According to a 2014 review of the scientific literature, intermittent fasting can cause weight loss of 3–8% over 3–24 weeks.

Lowering risk for Type II Diabetes

Intermittent fasting has been shown to have major benefits for insulin resistance, leading to an impressive reduction in blood sugar levels. In human studies on intermittent fasting, fasting blood sugar has been reduced by 3–6% over the course of 8–12 weeks in people with prediabetes. Fasting insulin has been reduced by 20–31%.

Beneficial for Heart Health

Intermittent fasting improves heart health by controlling the risk factors that lead to heart diseases. The risk factors include blood sugar levels, blood pressures, cholesterol levels and inflammatory markers.

Improve Sleep

Research suggests that intermittent fasting may improve sleeping quality by reinforcing the circadian rhythms.

Types of Intermittent Fasting

Time-Restricted Fasting (16/8 method)

The 16/8 method involves choosing of an eating window (about 8 hours) everyday and fast during the remaining 16 hours. It is also known as the Leangains protocol and can be very simple as we only have to skip our breakfast and not eating anything after dinner.

The easiest way to practice 16/8 method is to choose a 16-hours fasting period which include the time we spent sleeping. For example:

• 9 a.m. to 5 p.m.
• 10 a.m. to 6 p.m.
• 12 a.m. to 8 p.m.

Fast Diet (5:2 method)

It involves eating normal diet 5 days a week and restricting the calorie intake to 500 – 600 in the other 2 days. During the fast, the calorie intake is limited to 500 for women and 600 for men respectively.

For example, we may have normal diet every day of the week except Friday and Saturday. For those 2 days, we can eat 2 or 3 small meals with total calories not exceeding the limit.

Eat Stop Eat

Following this method, one has to practice a 24-hours fast once or twice per week. Important tip here is to eat responsibly after the fast. Eating responsibly refers to eating normal diet where we don’t binge because we just fasted, but we also don’t restrict ourselves with an extreme diet (eating more or less than we need).

For example, if we finish our dinner at 7p.m., then the next meal should be on 7.pm. the next day. By this, we have completed a 24-hours fast. Water, coffee, and zero-calories beverages are allowed during this period to help with the fast.

This method may be difficult for many people to follow. However, we can start with 14 hours fast and slowly increase to 24 hours.

Alternate Day Fasting

There are several different versions of this method. Some of them allow 500 calories (about 25% of calorie need) during the fast and eat normally during the non-fasting days. A full fast every other day can be rather extreme and is not recommended to beginners.

Fasting Tips

1. Drink cinnamon tea during the fast to help suppress the appetite.
2. Exercise just before or during the eating window.
3. Meditation during the fasting period to pass the hunger pangs.
4. Practice balance and healthy diet.
5. Always check with your primary care provider before starting any restrictive eating plan.

Who Should Avoid Intermittent Fasting

1. Teenagers under 18 years old.
2. Pregnant or breastfeeding women.
3. People with diabetes mellitus.
4. People with eating disorders such as anorexia.

References

1. Mosley M, Spencer M. The FastDiet: Lose Weight, Stay Healthy, and Live Longer with the Simple Secret of Intermittent Fasting. Atria Books. 2013
2. Williams KV, Mullen ML, Kelley DE, Wing RR. The effect of short periods of caloric restriction on weight loss and glycemic control in type 2 diabetes. Diabetes Care. 1998;21:2–8.
3. Varady KA, Bhutani S, Klempel MC, et al. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J. 2013;12:146.
4. LeCheminant JD, Christenson E, Bailey BW, Tucker LA. Restricting night-time eating reduces daily energy intake in healthy young men: a short-term cross-over study. Br J Nutr. 2013;110:2108–2113.
5. Ekmekcioglu C, Touitou Y. Chronobiological aspects of food intake and metabolism and their relevance on energy balance and weight regulation. Obesity Reviews. 2011;12:14– 25.

It’s normal to lose hair and we can lose between 50 and 100 hairs a day, often without noticing. Hair loss is not usually anything to be worried about, but occasionally it can be a sign of a medical condition. Baldness typically refers to excessive hair loss from your scalp. Hereditary hair loss with age is the most common cause of baldness. Some types of hair loss are permanent, like male and female pattern baldness.

Types of Alopecia

Signs and Symptoms

1. Gradual thinning on top of head. This is the most common type of hair loss, affecting people as they age. In men, hair often begins to recede at the hairline on the forehead. Women typically have a broadening of the part in their hair.
2. Circular or patchy bald spots. Some people lose hair in circular or patchy bald spots on the scalp, beard or eyebrows. Your skin may become itchy or painful before the hair falls out.
3. Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning but is temporary.
4. Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.
5. Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.

Causes

• Family history

The most common cause of hair loss is a hereditary condition that happens with aging. This condition is called androgenic alopecia, male-pattern baldness and female-pattern baldness. It usually occurs gradually and in predictable patterns — a receding hairline and bald spots in men and thinning hair along the crown of the scalp in women.

• An Ilness

A variety of conditions can cause permanent or temporary hair loss, including hormonal changes due to pregnancy, childbirth, menopause and thyroid problems.

• Stress

Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary.

• Cancer treatment
• Weight loss
• Iron deficiency

Prevention

Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness). This type of hair loss is not preventable.

These tips may help you avoid preventable types of hair loss:

• Be gentle with your hair. Use a detangler and avoid tugging when brushing and combing, especially when your hair is wet. A wide-toothed comb might help prevent pulling out hair. Avoid harsh treatments such as hot rollers, curling irons, hot-oil treatments and permanents. Limit the tension on hair from styles that use rubber bands, barrettes and braids.
• Ask your doctor about medications and supplements you take that might cause hair loss.
• Protect your hair from sunlight and other sources of ultraviolet light.
• Stop smoking. Some studies show an association between smoking and baldness in men.
• Avoid high-heat hair styling tools.
• Don’t chemically treat or bleach your hair.
• Use a shampoo that’s mild and suited for your hair

Treatment

Most hair loss does not need treatment and is either temporary and it’ll grow back or a normal part of getting older. However, effective treatments for some types of hair loss are available. Treatments for hair loss include medications and surgery.

Medication

• Minoxidil (Regro, Minox). Products with minoxidil help many people regrow their hair or slow the rate of hair loss or both. It’ll take at least six months of treatment to prevent further hair loss and to start hair regrowth. It may take a few more months to tell whether the treatment is working for you. If it is helping, you’ll need to continue using the medicine indefinitely to retain the benefits. Possible side effects include scalp irritation and unwanted hair growth on the adjacent skin of the face and hands.

• Finasteride (Propecia). This is a prescription drug for men. You take it daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show new hair growth. It may take a few months to tell whether it’s working for you. You’ll need to keep taking it to retain any benefits. Finasteride may not work as well for men over 60. Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets.

• Other medications. Other oral options include spironolactone and oral dutasteride (Avodart).

Hair Transplant Surgery

In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant, or restoration surgery, can make the most of the hair you have left. During a hair transplant procedure, a dermatologist or cosmetic surgeon removes hair from a part of the head that has hair and transplants it to a bald spot. Each patch of hair has one to several hairs (micrografts and minigrafts). Sometimes a larger strip of skin containing multiple hair groupings is taken. This procedure doesn’t require hospitalization, but it is painful so you’ll be given a sedation medicine to ease any discomfort. Possible risks include bleeding, bruising, swelling and infection. You may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.

Supplements

• Biotin

Biotin (vitamin B7) is important for cells inside your body. Low levels of it can cause hair loss, skin rashes, and brittle nails.

• Zinc

Zinc can play a key role in making proteins in your hair and other cells. Your body can’t make it, so you need to get it from food or supplements. Signs of low zinc levels include hair loss, poor wound healing, and a weak sense of taste or smell. 

References

1. Androgenetic alopecia. Retrieved from: https://medlineplus.gov/genetics/condition/androgenetic-alopecia/#references
2. Hair loss. Retrieved from: https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926
3. Wasserman D, Guzman‐Sanchez DA, Scott K, McMichael A. Alopecia areata. International journal of dermatology.

Pneumonia is an infection that causes inflammation of the air sacs in one or both lungs. The air sacs may be filled with fluid or pus (purulent material) which causes cough with phlegm or pus, fever, chills, and difficulty in breathing. There are a variety of organisms that can cause pneumonia which includes bacteria, viruses and fungi.

Pneumonia can be mild or even life-threatening. It can cause most serious damage to infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Symptoms

The signs and symptoms of pneumonia may vary for different individuals. It depends on factors such as the type of bacteria causing the infection, the patient’s overall health. Besides, the signs and symptoms can range from mild to severe. Mild signs and symptoms usually are almost identical to those of a common cold or flu; however, they will last longer.

Most of the pneumonia patients will experience chest pain when breathing or coughing, having confusion, productive cough (with phlegm), fatigue, fever, sweating, chills, nausea, vomiting, diarrhea and shortness of breath. For patients age 65 and above, they also experience signs and symptoms such as changes in mental awareness and lower body temperature. There may be no signs or symptoms at all in newborns and infants. However, some newborns and infants may vomit, fever, cough, lethargy and have difficulty in breathing and eating if they are infected.

Causes

The common causes of pneumonia include viruses, bacteria and fungi. For example, the common causes of viral pneumonia are influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19). On the other hand, the common cause of bacterial pneumonia is Streptococcus pneumoniae (pneumococcus). However, it is hard for the physicians to detect which bacteria causes the pneumonia in patients.

We also say it is community-acquired pneumonia when someone got the pneumonia in the community (not in a hospital). While if someone develops pneumonia in a healthcare setting (hospital, long-term care facilities, dialysis centre), that would be considered as healthcare-associated pneumonia. Ventilator-associated pneumonia is when someone develop pneumonia after using ventilator (a machine that supports breathing).

Risk Factors

Pneumonia can affect anyone regardless of the age; however, children under 2 years old and adult above 65 years old are at the highest risk to get pneumonia. Even the signs and symptoms are more severe in this age group.

There are few risk factors that may contribute to developing of pneumonia, such as being in hospital as the patient’s immune system is already weakened especially if the patient is using a ventilator, the risk is even greater. Having a chronic disease such as COPD, asthma, heart disease, diabetes will pose a greater risk to the patient. People with suppressed immune system either due to disease or taking immunosuppressants will also have a greater risk of contracting pneumonia. 

There are some lifestyles that will increase the risk of getting pneumonia. For example, smoking will compromise the immune system’s ability to defend itself. Drug or excessive alcohol use will also increase the risk of developing pneumonia as one may aspirate food, drink or vomit into the lungs. Being malnutrition also contributes to a higher risk of contracting pneumonia and a higher death risk.

Treatment

A mild pneumonia can be usually treated at home with rest and antibiotics (if the cause is bacteria). Drinking plenty of fluid is also necessary in recovery from pneumonia. Antibiotics should be taken as prescribed by doctors following the course even if the patient already feels better. This is because if stopped half way without finishing the antibiotic course, it will create an antibiotic resistant in the bacteria which help the bacteria to evolve and become stronger. There is a general guideline for the recovery of pneumonia.

• 1 week: high temperature should have reduced
• 4 weeks: chest pain and mucus production should have slowly decreased
• 6 weeks: cough and breathlessness should have substantially reduced
• 3 months: most symptoms should have reduced, just the patient may still feel fatigue
• 6 months: many people will feel back to normal

However, if there is no improvement after three days of starting antibiotics, the patient should go to doctor. This may due to the bacteria causing the infection is actually resistant to the antibiotic prescribed by the doctors or the pneumonia is not caused by bacteria rather it is caused by virus.

Painkillers such as paracetamol and ibuprofen usually will be given also to cope with the pain and fever. Cough medicine can also help to relive the cough and phlegm so that the patient can have a good rest.

There will usually be a follow up with doctor after 6 weeks of starting an antibiotics course. A chest X-Ray may be needed for patient whose symptoms have no improvement at all or the symptoms come back after they have gone away.

Hospitalization may be needed for patient who is older than 65 years old, having signs of confusion, declined kidney function, low blood pressure, rapid breathing, need breathing assistance, low body temperature or a rapid heart rate.

Prevention

Pneumonia can be prevented by getting vaccination. Taking a flu shot every year can help to prevent seasonal flu. It is important as flu is a common cause of pneumonia. Certain group of people should also take vaccination against pneumococcal pneumonia as it is a common form of bacterial pneumonia. This group of people includes children younger than 2, children aged 2 to 5 but with chronic disease, adults aged 19 to 64 with chronic disease such as asthma, COPD, diabetes and also includes all adults older than 65 years old.

Regularly hand washing especially after coughing or blowing your nose can also reduce the risk of getting pneumonia. Avoid smoking as tobacco damages the lungs’ ability to fight infection, which will expose the smoker to higher risk of getting pneumonia.

Good habits such as eating healthy diet, having sufficient rest and exercise regularly can keep one from illness. They also help to boost the recovery from respiratory illness such as cold and flu. Patient with existing respiratory health conditions such as asthma, COPD, diabetes and heart disease should also manage their condition well to lower the risk of getting pneumonia.

Reference

– Pneumonia. https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204#:~:text=Pneumonia%20is%20an%20infection%20that,and%20fungi%2C%20can%20cause%20pneumonia. Mayo Clinic. June 13, 2020.
– Causes of Pneumonia. https://www.cdc.gov/pneumonia/causes.html#:~:text=Common%20Causes%20of%20Pneumonia,is%20Streptococcus%20pneumoniae%20(pneumococcus). Centers for Disease Control and Prevention. October 22, 2020.
– Causes and Risk Factors of Pneumonia. https://www.verywellhealth.com/pneumonia-causes-risk-factors-770691. Verywell Health. Accessed April 8, 2022.
– The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis – World. https://reliefweb.int/report/world/impact-childhood-malnutrition-mortality-pneumonia-systematic-review-and-networkmeta#:~:text=We%20estimated%20a%20median%2018.3,dramatically%20increases%20with%20malnutrition%20severity. ReliefWeb. Accessed April 8, 2022.
-https://www.nhs.uk/conditions/pneumonia/treatment/#:~:text=Mild%20pneumonia%20can%20 usually%20be,cases%20may%20need%20hospital%20treatment. NHS Choices. Accessed April 8, 2022.
– Preventing Pneumonia. https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/preventing-pneumonia#:~:text=Get%20a%20flu%20shot%20every,Children%20younger%20than%202. American Lung Association. Accessed April 9, 2022.

Superfood is a term that is commonly used to describe foods that offers multiple health benefits through its nutrient contents, beyond providing energy. Consumption of these foods is linked with disease prevention and improved quality of life.

The idea of superfoods offers longevity and vitality has long been described in various cultures. Recent findings on essential fatty acids, dietary fibers, essential micronutrients and antioxidants make them the main substances related to superfoods.

Superfood such as Omega-3 and Omega-6 fatty acids must be obtained in diet as the human body does not produce them naturally. Better known types of omega-3 fatty acids, Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are mainly associated with benefits for the heart. They reduce inflammation, improve blood flow, prevent formation of fat deposit in blood vessel, and reduce triglyceride levels. Consuming a diet enriched with EPA and DHA can lead to less frequent and milder headache in patients with migraine, while moderate intakes may also delay cognitive function decline in elderly men. Some studies suggest that dietary interventions combined with pharmacological treatments might have an additive benefit in prevention of such condition.

Micronutrients are vitamins and minerals which are consumed in small quantities but are nonetheless essential for physical and mental development. There is a long list of essential micronutrients, however the ones that are particularly deficient in diets include iron, zinc, calcium, iodine, vitamin A, B-vitamins, and vitamin C. Effects of these micronutrient deficiency includes night blindness, eyesight problems, anemia and stunted growth.

Some superfoods confer benefit to digestive health via dietary fibers. These includes soluble fibers (inulin) and non-digestible carbohydrates (oligosaccharides), better known as prebiotics that helps nourish microflora in the intestines. Insoluble fibers help with bowel movement, reduces risk of intestinal diseases and helps in weight control.

Phytochemicals found in plants provide their colors and characteristic smell. There are multiple different types of known phytochemicals which includes tannins, flavonoids, and saponins. These chemicals are produced by plants for their own benefit and do not have nutritional value for human. Yet, they have been found to provide multiple health benefits via antioxidant properties, hailed for preventing cancer, protecting cells from damage, and reducing signs of ageing.

One popular example of superfood would be the Goji berry, originating from China. Also known commonly as Wolfberry, they contain phytochemicals zeaxanthin dan carotene which are important in maintaining healthy eyesight. They can be taken as part of the diet, providing energy through complex sugar and protein contents. Carbohydrates betaine, cerebroside, beta-sitosterol in Goji berry help counter nerve damage in neurodegenerative diseases and protect the eyes from glaucoma –both are important especially in ageing populations.

A lot of wholegrains have also been discussed to have superfood property. An analysis of more than 3000 middle- and older-aged American adults over years indicates taking more whole grains in diet may protect against heart disease. Person who ate at least 3 servings of whole grains daily had smaller increases in blood sugar levels, blood pressure, and waist size compared with persons who ate less than one-half serving per day.

An excellent example of super grain is Quinoa. It provides a rich supply of protein, dietary fibers, several B vitamins, dietary minerals, magnesium, phosphorus, and manganese. Quinoa seeds also have low glycemic index, it provides energy source in small, lasting amount, which makes it a good staple food item. Raw quinoa seeds provide polyphenols at a higher level compared to many fruits and vegetables. Polyphenols are known to have powerful anti-inflammatory benefits for the body, and it is believed that they could help to reduce the risk of some cancers, cardiovascular disease and other illnesses too. Indigestible carbohydrate fibres called oligosaccharides found in the grain act as prebiotic, they provide nutrients for intestinal microflora.

Pumpkin, a fruit that is more nutritionally similar to vegetables, is a filling, nutrient-dense food with multiple health benefit. It’s very high in antioxidants, such as alpha-carotene, beta-carotene and beta-cryptoxanthin. These can neutralize free radicals, stopping them from damaging human cells. High content of vitamins A, C, and E, iron and folate help strengthen immunity. Pumpkins’ high vitamin A, lutein and zeaxanthin contents can protect the eyes against sight loss, which becomes more common with age. Pumpkin is also a good source of fiber and helps suppress appetite. It has mildly diuretic property, eating a lot of pumpkin may induce a “water pill”-like reaction, increasing the amount of water and salt the body expels through urine. This is particularly beneficial for people concerned with their blood pressure.

The beetroot is the taproot portion of a beet plant, one of several cultivated varieties of Beta vulgaris. Beetroot had been used as part of traditional remedy for multiple health benefits, particularly relating to blood and heart health. Studies have shown that beetroot juice can modestly help reduce blood pressure. Beetroot can be eaten raw, used for juice extraction, baked or boiled. Polyphenols and dietary fiber in red beetroot juice helps diminish blood cholesterol level by stimulating excretion of cholesterol in intestines. It has also been studied to stop weight gain and reduce cholesterol in obese individuals. Beetroot is rich in soluble dietary fiber that provide moderate increase in blood sugar level post-meal, and especially beneficial in pre-diabetic.  Regular consumption as part of diet also appears to positively influence physiological response to exercise. Therefore, beet root is an especially valuable super food for people concerned with their body weight and cardiovascular risks.

Although a lot of superfoods are from plant origin, fatty fishes are one of the exceptions. They provide essential proteins not commonly found in plants, which the human body use for energy production, growth, and repair. Fatty fishes found in cold water such as salmon, trout, and sardines contain higher level of omega-3 fatty acids compared to their warm-water counterparts. These benefits are however offset by risk of heavy metal contamination in larger fish. Thus, it is only recommended to take one to two servings of the fish weekly.

To get the best result from superfoods, is it best to consume them raw, cooked, or processed? The answer depends on which superfood one is referring to. In general, taking them as closely to their natural form is preferable to retain its nutrients. Juicing of beetroots, natural drying of goji berries, and removing the outermost shell of quinoa helps improve palatability and ease consumption. However, excessive consumption beyond dietary recommendation exposes to other risks. Red beet root, for example, accumulates oxalic acid responsible for causing kidney stones. Larger fatty fish may also have heavy metal content in their muscle tissue and may adversely affect some populations proportionately. In these cases, taking pre-processed food or supplements focusing on their benefit may be the wiser choice.

Most of the studies that display theoretical health benefits of these food products would use extracts in laboratory. In experimental studies, the method to gain the extract themselves are usually more vigorous than is possible in human digestive system. Therefore, a lot of the supporting studies may overestimate or underestimate the actual health benefit when we consume the food as part of our diet.

It is also important to note that phytochemical content may vary among species, cultivation method, and food handling prior to consumption. The magnitude of potential risks that may be associated with phytochemicals is still unclear, especially when taken in large doses as supplements. These extracted substances may have possible side effects or may interact with other substances in the body, e.g., medications. There are only few documented cases suggesting that certain phytochemicals may also be harmful. For instance, some studies have shown that overdosing on beta-carotene may increase the risk of lung cancer in smokers. Therefore, you should always speak to your healthcare provider before taking phytochemical supplements. Taking it as functional food in moderation is probably safer in the long run.

To quote the 2021 Dietary Guidance to Improve Cardiovascular Health scientific statement, developed under chair of the American Heart Association’s writing group, one can improve cardiovascular health and reduce cardiovascular risk with an emphasis on dietary patterns and food-based guidance beyond naming individual foods or nutrients. It is important to first emphasize on balanced diet, and to take superfoods strategically to enrich our nutrient consumption.

References

1. Quinoa – Wikipedia [Internet]. En.wikipedia.org. 2022 [cited 18 April 2022]. Available from: https://en.wikipedia.org/wiki/Quinoa
2. 9 Super Grains With Health Benefits You Need to Try [Internet]. HubPages. 2022 [cited 18 April 2022]. Available from: https://discover.hubpages.com/health/Super-Grains-Your-Guide-To-The-Newest-Hollywood-Superfoods
3. Superfoods or Superhype? [Internet]. The Nutrition Source. 2022 [cited 18 April 2022]. Available from: https://www.hsph.harvard.edu/nutritionsource/superfoods/
4. Barsby J, Cowley J, Leemaqz S, Grieger J, McKeating D, Perkins A et al. Nutritional properties of selected superfood extracts and their potential health benefits. PeerJ. 2021;9:e12525.
5. The Role of Proteins, Fats and Carbohydrates in Our Diet and Health [Internet]. Healthpedian.org. 2022 [cited 18 April 2022]. Available from: https://www.healthpedian.org/the-role-of-proteins-fats-and-carbohydrates-in-our-diet-and-health/
6. Omega-3-enriched diet cuts headache days | Latest news for Doctors, Nurses and Pharmacists | Pharmacy [Internet]. MIMS News. 2022 [cited 4 April 2022]. Available from: https://specialty.mims.com/topic/omega-3-enriched-diet-cuts-headache-days-in-migraine-
7. Kendall C, Esfahani A, Jenkins D. The link between dietary fibre and human health. Food Hydrocolloids. 2010;24(1):42-48.
8. Ritchie H, Roser M. Micronutrient Deficiency [Internet]. Our World in Data. 2022 [cited 3 February 2022]. Available from: https://ourworldindata.org/micronutrient-deficiency?utm_medium=syndication&utm_source=scribd#hidden-hunger-index
9. Goji berries a potential arsenal against age-related macular degeneration | Latest news for Doctors, Nurses and Pharmacists | Multidisciplinary [Internet]. MIMS News. 2022 [cited 18 April 2022]. Available from: https://specialty.mims.com/topic/goji-berries-a-potential-arsenal-against-age-related-macular-degeneration?channel=multi-specialty&utm_medium=email&_hsmi=202393192&_hsenc=p2ANqtz-9bZXdq_h6_uBQH5DFoIcHXH-iS6Za-A0TknP3rGbXfJvYHIX78OtHoVU4MvlP-E88nUmrjbXdxANrUdkqdI0dmHTgCVQ&utm_content=202393192&utm_source=hs_email
10. Phytochemicals and their Potential Health Benefits [Internet]. Healthpedian.org. 2022 [cited 18 April 2022]. Available from: https://www.healthpedian.org/phytochemicals-and-their-potential-health-benefits/
11. Sawicki C, Jacques P, Lichtenstein A, Rogers G, Ma J, Saltzman E et al. Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort. The Journal of Nutrition. 2021;151(9):2790-2799.
12. Barsby J, Cowley J, Leemaqz S, Grieger J, McKeating D, Perkins A et al. Nutritional properties of selected superfood extracts and their potential health benefits. PeerJ. 2021;9:e12525.
13. Saravanan V, Manokaran S. Physico-chemical studies and evaluation of diuretic activity of &lt;i&gt;Cucurbita maxima&lt;/i&gt;. Bangladesh Journal of Pharmacology. 2012;7(4).
14. Beetroot – Wikipedia [Internet]. En.wikipedia.org. 2022 [cited 18 April 2022]. Available from: https://en.wikipedia.org/wiki/Beetroot
15. Siervo M, Lara J, Ogbonmwan I, Mathers J. Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis. The Journal of Nutrition. 2013;143(6):818-826.
16. Vega C. What Is a Heart-Healthy Diet? American Heart Association Weighs in With New Dietary Recommendations. Presentation presented at; 2021; Medscape.org.

Types

Technically there is a huge difference between sunblock and sunscreen. Sunblock, as its name suggested, uses physical blockers like zinc or titanium oxide to guard the skin against UV rays. On the other hand, sunscreen uses active ingredients that readily absorb the sun’s rays. The active ingredients of sunscreens are more easily absorbed into the skin.

Choose The Right One

1. Broad Spectrum Sunscreen

This type of sunscreen protects against both UVA and UVB rays. UVA rays are the one that contribute to skin cancer and premature aging while UVB rays can cause sunburn. Only products that pass a certain test can be labeled “broad spectrum.” Most of the products aren’t broad spectrum hence they can only protect against sunburn, not skin cancer or skin aging.

2. Sun Protection Factor (SPF)

SPF is a measure of how much UVB light can be filtered out by a sunscreen. The American Dermatology Association (ADA) recommends using an SPF of at least 30. SPF 15 blocks about 93 percent of UVB rays, while SPF 30 blocks about 97 percent of UVB rays. 

3.Your Skin Type

For those who have dry skin should pick a sunscreen that doubles as a moisturizer.

For those who have oily and acne-prone skin, a water-based sunscreen instead of oil-based sunscreen is recommended.

On the other hand, for those with skin that is more sensitive and prone to irritation, they shall avoid products with alcohol, preservatives, fragrances, and oxybenzone.

The best sunscreen for kids should be at least SPF50. Choose sunscreens that are specifically made for kids as adult sunscreens can sometimes irritate their gentle skin. Babies need even stronger sun protection, as their skin is thinner and more. sensitive.

4.Level Of Sun Exposure

Duration of exposure to sunlight, the weather, and type of activities while being exposed to the sun are the factors that need to be taken into consideration. Typically, the strength of the sun is measured by the Ultraviolet (UV) Index, which ranges from 1 (low) to 11+ (extreme). These UV rays are the strongest from 10 a.m. to 4 p.m., and when the UV Index is at 8 or above, our unprotected skin can burn in 15 minutes or less.

For instances,

– Outdoors: choose sunscreen with at least SPF 30 or higher if you are mostly outdoors for an extended period (two hours or more), depending on your skin color.

– Sports/swimming: choose a sweat-resistant or water-resistant sunscreen with at least SPF 30 or higher, depending on your skin color, and reapply every 40 to 60 minutes.

– Every day: choose sunscreen with at least SPF 15 on regular basis if you will be in the sun and shade.

5. Types of Formulation and Packing

Sunscreen formulation refers to how a sunscreen is formulated either an oil-in-water or water-in-oil emulsion. It can be formulated in lotion, gel or cream thus it will give different textures and looks on an individual’s skin.

There are few common sunscreen formulations available on the market such as sunscreen sprays, sunscreen lotion and sunscreen stick. In general, all sunscreens have a shelf life of three years from the date of manufacture.

6. Water Resistance

There is a myth saying that “water resistant” means “waterproof.” No sunscreens are waterproof or “sweatproof,” you’ll need to reapply once you expose your skin to water with the product on, after a stipulated amount of time. Usually, reapplication of sunscreen at least every 2 hours is most favorable. If a product’s label makes claims of being water resistant, it must indicate whether it lasts for 40 minutes or 80 minutes while swimming or sweating.

Tips for sun-safe

• Wear clothing and wide-brimmed hat to protect the skin as much as possible. Pair up with sunglasses that block at least 99 percent of UV light to protect your eyes
• Look for shade. Limit direct exposure to the sun, especially between the hours of 10 a.m. and 4 p.m., when UV rays are the strongest.
• Avoid tanning beds and sunlamps. 
• Always remember to apply sunscreen or sunblock 15 minutes before you go outdoor to maximize the benefit of sunscreen.

References

1. How to choose the best sunscreen, according to these dermatologists. [Internet]. Better By Today. 2019 [cited 5th June 2022]. Available from: https://www.nbcnews.com/better/lifestyle/how-choose-best-sunscreen-according-these-dermatologists-ncna1002451?featureFlag=true#anchor-NextconsidertheSunProtectionFactorSPF
2. How to Choose Sunscreen. [Internet]. StyleCraze. 2022 [cited 5th June 2022]. Available from https://www.stylecraze.com/articles/things-to-consider-when-choosing-a-sunscreen/
3. How Does Sunscreen Work to Protect Your Skin? [Internet]. Colorescience. 2018.[cited 5th June 2022]. Available from https://www.colorescience.com/blogs/learn/how-does-sunscreen-work-to-protect-your-skin
4. Sunscreen: How to Help Protect Your Skin from the Sun. [Internet]. FDA. 2021. [cited 5th June 2022]. Available from https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun
5. Choose the Right Sunscreen. [Internet]. cancer.org 2018. [cited 5th June 2022]. Available from https://www.cancer.org/latest-news/choose-the-right-sunscreen.html
6. How To Choose Sunscreen To Suit Your Skin Type. [Internet]. Dermaster. 2021.  [cited 5th June 2022]. Available from https://dermaster-thailand.com/en/resource/how-to-choose-sunscreen-to-suit-your-skin/

Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and non-infectious agents such as drugs, toxic agents, alcohol or certain genetic disorders leading to a range of health problems, some of which can be fatal. In some cases hepatitis is also the result of auto-immune reaction when the immune system mistakenly attacks the liver.

There are five main viral classifications of hepatitis, which are hepatitis A, B, C, D, and E. Different virus is responsible for each type of viral hepatitis. The World Health Organization (WHO) estimates that around 354 million people are currently living with hepatitis B and C.

Hepatitis A

Hepatitis A is caused by hepatitis A virus (HAV). It can be spread through contaminated food and water. It is the easiest to be transmitted from one person to another person, especially among children, but is also the least likely to damage the liver. This type of infection is a short-term disease and is completely resolved within six months.

Hepatitis B

Hepatitis B is caused by hepatitis B virus (HBV). It can be spread through exposure to contaminated blood, needles, syringes or bodily fluids and from mother to baby. This is a chronic condition, in some cases it may lead to liver damage, liver cancer and cirrhosis in long term.

Hepatitis C

Hepatitis C is caused by hepatitis C virus (HCV). Hepatitis C is only transmitted through infected blood or from mother to baby during childbirth. It also can lead to cirrhosis and liver cancer in long term.

Hepatitis D

Hepatitis D is only found in people who are also infected with hepatitis B.

Hepatitis E

Hepatitis E is a waterborne disease that results from exposure to the hepatitis E virus (HEV). Hepatitis E is usually spread via contact with food or water that was contaminated with an infected person’s stool.

Autoimmune Hepatitis

In some cases, the immune system mistakes the liver cells as harmful invaders and attacks them. This causes ongoing inflammation that can range from mild to severe, often hindering liver function. It’s three times more common in women than in men.

Symptoms

Fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-coloured urine and jaundice.

Causes

• Viral hepatitis can be caused by several viruses such as hepatitis viruses A, B, C, D, and E. 
• Alcoholic hepatitis can be caused by excess alcohol consumption.
• Toxic hepatitis can be caused by certain medicines, chemicals, poisons.
• Autoimmune happens when the immune system attacks liver cells, this condition is usually chronic.

Risk of Hepatitis

• Sharing needles or other objects that might be contaminated with hepatitis viruses
• Engaging in unsafe sexual contact, such as not using a condom during sex, having rough sex, or having multiple sexual partners
• Working around toxic chemicals. Examples of occupations routinely exposed to such chemicals include dry cleaners, painters, healthcare providers, or farm workers.
• Drinking untreated water or eating food that has not been safely or properly prepared (ex. unwashed produce)
• Drinking large quantities of alcohol over a long period of time
• Taking medications believed to be linked to hepatitis
• Not being vaccinated against viral hepatitis, specifically HAV and HBV
• Having an acute or chronic infection with one or more hepatitis viruses
• Having an autoimmune disorder
• Being born to a mother who is infected with a hepatitis virus, particularly hepatitis B

Diagnosis of Hepatitis

• Doctor will first take your medical history and symptoms.
• Physical exam will be done, which may or may not reveal a swollen, enlarged liver.
• Liver function tests, blood test (to check the presence of viral hepatitis) or ultrasound
• A liver biopsy to check for liver damage.

Treatment of Hepatitis

Treatment for hepatitis depends on which type of hepatitis you have and whether it is acute or chronic.

• Bed rest, refraining from alcohol, and taking medication to relieve symptoms.
• Most people who have hepatitis A and E get well on their own after a few weeks.
• Chronic Hepatitis B can be treated with antiviral medications
• Hepatitis C can be treated with a combination of antiviral drugs.
• Liver transplant may be needed if patient’s chronic hepatitis may lead to liver failure or liver cancer.

Prevention of Hepatitis

Get vaccines for hepatitis A and hepatitis B

Vaccination for hepatitis A is available and can help to prevent the contraction of HAV. The hepatitis A vaccine is a series of two doses and most children will be vaccinated at age 12 to 23 months. This vaccination is also available for adults and can also include the hepatitis B vaccine.
The CDC recommends hepatitis B vaccinations for all newborns. Doctors typically administer the series of three vaccines over the first 6 months of childhood.
The CDC also recommends the vaccine for all healthcare and medical personnel. Vaccination against hepatitis B can also prevent hepatitis D.
There are currently no vaccines that can prevent contraction of hepatitis C or E.

• Wash your hands after going to the bathroom and before handling food or eating.
• Use latex condoms, which may lower the risk of transmission.
• Don’t share drug needles.
• Don’t share personal items such as toothbrushes, razors and nail clippers with an infected person.
• Avoid raw or undercooked shellfish and oysters
• Take precautions when getting any tattoos or body piercings.
• Take precaution when traveling to areas of the world with poor sanitation. (Make sure to get vaccinated before your trips.)
• Drink bottled water when traveling.

References

1. World Health Organization (WHO). Hepatitis. Available at  https://www.who.int/health-topics/hepatitis#tab=tab_1
2. Healthline. Hepatitis. Available at https://www.healthline.com/health/hepatitis
3. MedlinePlus. Hepatitis. Available at https://medlineplus.gov/hepatitis.html
4. Johns Hopkins medicine. Health. Hepatitis. Available at https://www.hopkinsmedicine.org/health/conditions-and-diseases/hepatitis
5. Verywell health. Causes and risk factors of hepatitis. Available at  https://www.verywellhealth.com/hepatitis-causes-and-risk-factors-4689127#:~:text=Environmental%20risk%20factors%20associated%20with,blood%20infected%20with%20hepatitis%20viruses
6. Cleveland clinic. Viral hepatitis. Available at https://my.clevelandclinic.org/health/diseases/4245-hepatitis-viral-hepatitis-a-b–c#:~:text=There%20are%20many%20ways%20you,washing%20with%20soap%20and%20water

What is acne? Acne or pimples can present as whiteheads or blackheads (close and open comedones) or inflamed papules, nosules or cysts. (1)

The severity of acne is often categorized as:

• Mild which is mostly whiteheads and blackheads, with a few papules and pustules;
• Moderate which is more widespread whiteheads and blackheads, with many papules and pustules;
• Severe which has lots of large, painful papules, pustules, nodules or cysts and you may also have some scarring! (2)

So, how is acne formed? There are three main factors for acne formation. Let’s see the factors as belows:

1. The skin cells are not shredded properly which cause plugging of pores.
2. Androgen hormones which are present in both males and females regulate oil production in the skin. During adolescence, increased androgens or increased response to androgen can cause increased oil or sebum production.
3. Overgrowth of Propionibacterium acnes bacteria within hair follicles.
4. All the above factors will eventually cause inflammation and swelling of the hair follicles, result in acne formation. (1)

Do you know what factors that may worsen acne?

• Milk and foods with high glycemic index such as white rice, glutinous rice, white bread, cornflakes, fried noodles, boiled potato, watermelon and the tarik may worsen acne.
• Stress may also worsen acne. In some studies, exam stress worsens their acne.
• Smoking may worsen acne too when smoker has lower level Vitamin E and cause higher level of oxidized sebum.

Acne Do’s

1. Wash your face twice a day with water and gentle, oil-free cleanser.
2. If you wear make-up, preferably use oil-free and water-based products and remove them before sleep.
3. Apply acne medication to manage blemishes. Make sure you understand how to apply them correctly to get maximum benefit.
4. Use a water-based moisturizer to keep skin soft, smooth and hydrated if necessary.
5. Shampoo regularly and keep your hair off your face if you have long hair.
6. Replace cosmetic sponges and old brushes regularly to reduce bacteria.
7. Drink plenty of water, eat balanced diet and exercise regularly.
8. Stop smoking
9. Seek the advice from doctor if your skin condition doesn’t improve.

Acne Don’t

1. Do not ignore your acne as it may cause permanent scarring
2. Do not squeeze or pick your acne as this can deepen the inflammation and cause scarring.
3. Do not use harsh scrubs and cleansers that may irritate or dry your skin.
4. Do not expose your skin to extreme temperature or sunlight.
5. Do not use greasy oil-based cosmetics that can clog pores and trigger breakouts.

Treatment for Acne

Mild Acne
You may use commercial products. Otherwise, one topical agent can be considered.

Moderate Acne
A combination of 2 topical agents or if more severe, an oral antibiotic (prescription-only) to be prescribed by a doctor.

Severe Acne
In presence of nodulocystic acne or acne not responding to treatment, referral to a dermatologist is required. (1)

Reference

• Patient Information Leaflet Acne Vulgaris. Malaysia: Ministry of Health, Dermatological Society of Malaysia, Academy of Medicine Malaysia; June 2012.
• NHS. Acne [Internet]. United Kingdom; 2019 [updated 2022 July 12; cited 2022 Aug11]. Available from: https://www.nhs.uk/conditions/acne/diagnosis/

What is high altitude sickness?

Ascending to or being at a new high altitude may cause high-altitude sickness. High altitude sickness includes acute mountain sickness (AMS), high-altitude cerebral edema (HACE) and high-altitude pulmonary edema (HAPE). High altitude sickness is a condition that occurs when people ascend to high altitudes (usually above 8,000 feet or 2,400 meters) too quickly without acclimatizing properly. Altitude sickness is caused by a lack of oxygen in the air, which can lead to a range of symptoms that can range from mild to life-threatening.

Acute mountain sickness (AMS)

Acute mountain sickness (AMS) is the most common of the altitude diseases; it occurs in approximately 40 to 50 percent of people who live at a low altitude and sleep at an altitude above 10,000 feet (3000 m), and in approximately 25 percent of those sleeping above 8000 feet (2400 m). Some people can develop AMS as low as 6500 feet (2000 m).

High-altitude cerebral edema (HACE)

High-altitude cerebral edema (HACE) is a rare, life-threatening altitude disease and is a severe form of acute mountain sickness (AMS). It is caused by leaky capillaries in the brain, which causes fluid accumulation and brain swelling. You may experience confusion, lack of coordination and possibly violent behaviour.

High-altitude Pulmonary Edema (HAPE)

High-altitude pulmonary edema (HAPE) is a potentially fatal condition in which lung capillaries leak and fluid accumulates in the lungs, causing breathlessness, even when resting. You feel very fatigued and weak and may feel like you’re suffocating. HAPE is uncommon but can occur in people who rapidly ascend to altitudes above 8200 feet (2500 m).

Symptoms

The symptoms of high-altitude sickness can range from mild to severe and usually appear within 6 to 24 hours after arrival at high altitude. The most common symptoms include:

• Headache
• Nausea
• Vomiting
• Fatigue
• Loss of appetite
• Dizziness
• Insomnia
• Shortness of breath
• Rapid heart rate

In severe cases, high altitude sickness can progress to high altitude cerebral edema (HACE) or high altitude pulmonary edema (HAPE), which can be life-threatening.

Risk Factors

It is not possible to know in advance if you will become ill when traveling to a high altitude. In addition, being physically fit does not decrease your chances of developing a high-altitude illness. However, certain groups are at increased risk, including people who:

• Have a prior history of high-altitude illness
• Overexert themselves before adjusting to the change in altitude
• Ascend rapidly (eg, within one day) from low elevation to sleeping altitudes above 9000 feet (2750 m)
• Have a medical problem that affects breathing

Treatment

The treatment for high altitude sickness depends on the severity of the condition. Mild symptoms of altitude sickness can often be relieved by descending to a lower altitude, resting, oxygen therapy and taking over-the-counter pain medications such as acetaminophen or ibuprofen. However, more severe cases of altitude sickness may require medical attention. Here are some treatments for high altitude sickness:

1. Medication

• Acetazolamide (Diamox) can help alleviate symptoms of altitude sickness by stimulating breathing and reducing fluid buildup in the lungs. However, it is important to consult with a healthcare provider before taking any medication.
• Dexamethasone is a steroid medication that can be used to treat severe cases of altitude sickness, such as high altitude cerebral edema (HACE).

2. Oxygen therapy

If you experience severe altitude sickness symptoms, oxygen therapy may be necessary to alleviate symptoms and prevent further complications.

Prevention

1. Gradual ascent. The best way to prevent high altitude sickness is to acclimatize properly. This involves gradually ascending to higher altitudes over several days, allowing the body to adjust to the lower oxygen levels.
2. Staying hydrated. Dehydration can worsen altitude sickness symptoms. Drink plenty of fluids, even if you don’t feel thirsty.
3. Eating a well-balanced diet. Eat a diet that’s more than70% carbohydrate as can help provide the energy and nutrients needed to cope with the physical stress of high altitude.
4. Avoiding alcohol. Alcohol can dehydrate your body. It also has stronger effects at higher elevations, which can impair judgment.
5. Rest. Take it easy for the first few days after reaching high altitude. Avoid strenuous activity until you feel acclimatized.
6.  “Climb high and sleep low”. If you have to climb over 1,000 feet in a day, make sure you come back down to a lower altitude to sleep.
7. Recognize symptoms. Be aware of the symptoms of altitude sickness and take action if they appear. Early recognition and treatment can prevent the condition from becoming more severe.

References

1. Altitude Sickness: What to Know?. https://www.webmd.com/a-to-z-guides/altitude-sickness
2. Altitude sickness. https://www.nhs.uk/conditions/altitude-sickness/#:~:text=You%20can%20get%20altitude%20sickness,a%20medical%20emergency%20if%20ignored.
3. Patient education: High-altitude illness (including mountain sickness) (Beyond the Basics). https://www.uptodate.com/contents/high-altitude-illness-including-mountain-sickness-beyond-the-basics/print
4. Cleveland Clinic. Altitude Sickness. Available from https://my.clevelandclinic.org/health/diseases/15111-altitude-sickness

Introduction

Influenza, also known as flu is classified into seasonal influenza, avian influenza and pandemic influenza. The influenza A outbreak in Malaysia is classified as seasonal influenza. Avian influenza occurs mainly in birds and poultry (chicken and ducks) and usually do not infect other species but if virus get mutated, there will be a possibility for human to get infected. Meanwhile, pandemic influenza occurs once every 10-50 years when an animal influenza virus (avian influenza) undergoes major genetic changes and develops into a new influenza virus that will be transmitted among human, leading to a pandemic.

Seasonal influenza that affects human can be divided into:

• Type A
• Type B

Influenza A viruses are caused by RNA viruses belonging to the Orthomyxoviridae family, which is categorized into subtypes based on the types of 2 proteins on the surface if the viral envelope:

• H= hemagglutinin is a protein that causes red blood cells to agglutinate.
• N= neuraminidase is an enzyme that cleaves the glycosidic bonds of the monosaccharide sialic acid.

Avian influenza is also known as the bird flu, caused by type A strain (H5N1) of the influenza viruses. Influenza A is a subtype of the type A influenza viruses. It can be found in many species, including humans, birds, horses, and pigs, due to the breadth of potential hosts and its ability to genetically change over a short period of times, influenza A viruses are every diverse. Normally, its capable of causing a pandemic.

Unlike influenza A viruses, type B influenza viruses are only found in human. Influenza B viruses are further classified into two lineages: B/Yamagata and B/Victoria and will not cause pandemics. Influenza B virus may cause lesser reaction than influenza A virus, but it is still extremely harmful.  

Transmission

Normally, airborne transmission occurs particularly in crowded enclosed spaces, from direct contact with droplets circulated by unprotected coughs and sneezes and contamination of the hands.

Risk group

• Pregnant women
• Children under 5 years old
• Elderly above 65 years old
• Patient with chronic disease (asthma, diabetic, heart and lung illness)
• Immunocompromised patient (HIV, cancer, chemotherapy patient or with steroid treatment)
• Obese

Incubation period:

The seasonal influenza that occurs yearly is type A and B with an incubation period of 1-4 days.

Sign & Symptoms:

Once the symptoms begin, one will experience high fever for 2-3 days. Influenza symptoms can range from mild to severe and they vary person to person:

• High fever
• Chest discomfort
• Cough
• Shortness of breath
• Sore throat
• Muscle pain
• Headache
• Sneezing
• Tiredness and fatigue
• Loss of consciousness
• Diarrhea and vomit

Complication:

High risk populations may develop complications:

• Pneumonia (lung infection)
• Encephalitis (brain infection)
• Heart diseases
• Rhabdomyolysis (Inflammation of muscle tissue)

Treatment:

Home remedies:

• Drink plenty of water
• Maintain a balanced diet
• Get enough of rest
• Avoid stress as it can weaken the body immune system
• Medications such as paracetamol or ibuprofen to treat fever or muscle pain
• Medications such as expectorants or mucolytics to treat cough and cold

Medication:

For Influenza A

• Antiviral medication is available by prescription only. It can shorten the duration of symptoms or prevent complications such as pneumonia. Antiviral medications such as Tamiflu (oseltamivir) or Relenza (zanamivir) can be started within 1-2 days of onset of influenza A symptoms and given around 3-5 days. Antibiotic are not effective against influenza virus at all.

Prevention:

Vaccine:

The World Health Organization (WHO) recognizes vaccination as one most effective way to prevent the influenza. Influenza vaccination provides protection for children and adults from different virus strains and help to reduce the disease transmission and complication. Vaccination takes 2 weeks to become fully effective for protection to develop after immunization and can last up to 1 year.

Precaution:

• Cover mouth and nose with tissue or handkerchief when sneezing or coughing
• Frequent hand wash with soap
• Wear a facemask while infect with influenza
• Avoid being in public places when having influenza

Reference:

1. https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
2. http://www.myhealth.gov.my/en/influenza-2/
3. https://www.healthline.com/health/cold-flu/influenza-a-vs-b
4. https://www.medicalnewstoday.com/articles/326672
5. https://www.homage.com.my/health/influenza/
6. https://specialty.mims.com/influenza/treatment?channel=respirology

What is Gut and Gut Micriobiota ?

Gut refers to the gastrointestinal or in simpler terms, the digestive system which starts from the mouth and ends at the rectum. It contains a number of microorganisms which are not visible to naked eye. Gut microbiota refers to all the microorganisms living in the same environment, while microbiome refers to all genes of these microbes. So, the gut microbiota refers to the large community of microbes that reside in the gut.

What is the function of Gut Microbiota ?

The gut microbiota plays an important role in digestion, absorption and metabolism of food. On the other hand, the gut bacteria are thought to play an important role in obesity, immune function and minimally responsible in influencing mood. In fact, our gut bacteria is said to have an impact on most of our physiological functions, directly or indirectly. While the research around the gut microbiota is still ongoing, it is clear that it is a key factor in several aspects of the body’s optimal functioning.

What are the common gut related disorders and why does it occur ?

In certain situations, such as a disease, the microbes that reside in your gut can be disrupted. This will be different from the microbe community that was present when your body was healthy. This is termed as dysbiosis. Dysbiosis can be caused by change in eating habits, bowel movements and even medications taken when one is ill. However, it is to note that whether these changes in the microbiota are helpful or not is still under research. Some of the most common gut related disorders you would have come across are constipation, indigestion and diarrhea. In addition, conditions such as irritable bowel syndrome (IBS), Crohn’s disease, Celiac disease, lactose intolerance and colitis are also gut related.

What can i do to maintain a healthy gut ?

The following tips can be incorporated into your daily life to ensure the gut microbes are functioning well in order to support your body to function optimally;

Diverse diet:

A large and diverse community of microbes resides in our gut. So, to support these microbes, our diet needs to be equally varied. Our food serves as substrates for these microbes to thrive. It is clear that the diversity of our diet determines the diversity and richness of the gut microbiota. The increasing number of fad diets is also an issue of concern as it encourages elimination of food groups, which in turn affect the diversity of the gut microbiota.

Fiber intake and polyphenols also play key role in shaping the microbiome. Low intake of fiber paired with high fat and sugar intake may reduce certain microbe groups in the gut. Polyphenols are found in foods like tea, chocolate, spice, seasonings, herbs and even fruits and vegetables. Interactions between polyphenols and the gut microbes can also impact health.

What can you do ?

Ensure your diet is diverse by varying the foods you eat on a daily basis. Consume fiber rich food such as whole grains, lentils/legumes, fruits and vegetables. Aim for at least 25-30g of fiber a day. It is important to note that fruits and vegetable are rich in polyphenols thus are able to provide much additional benefits.

Fermented Foods

Fermentation is a natural process by which bacteria break down substances into simpler forms. Examples of fermented food are kimchi, yoghurt and kefir among several others. These are commonly termed as ‘probiotics’ since they contain live cultures of microorganisms. While the research on probiotics is still ongoing, they do seem to show promising effects on enriching the existing gut flora.

Stress

This is something that affects each one of us on a day-to-day basis. While everyone knows that extreme stress is unhealthy, we never expect stress to also affect the diversity of microbes in our gut. Hence, get enough sleep and limit your involvement in anxiety inducing environment as much as possible to avoid disrupting your gut microbiota and maintain a healthy body.

Conclusion

In conclusion, gut health is a growing area of research. While there are still a number of questions left unanswered, the field seems vast and promising. It is clear that the gut plays an important role in several aspects of human health. Thus, it is necessary for us to understand this and nourish the gut by practicing a healthy lifestyle.

References:

1.Ursell L, Metcalf J, Parfrey L, Knight R. Defining the human microbiome. Nutrition Reviews. 2012;70(Suppl 1):S38-S44.

2. Shreiner AB, Kao, JY, Young, VB. The gut microbiome in health and disease. Current Opinion Gastroentology. 2015;31(1):69-75

3. Makki K, Deehan E, Walter J, Bäckhed F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host & Microbe. 2018;23(6):705-715. 

4.Sonnenburg E, Sonnenburg J. Starving our Microbial Self: The Deleterious Consequences of a Diet Deficient in Microbiota-Accessible Carbohydrates. Cell Metabolism. 2014;20(5):779-786.

5. Ozdal T, Sela D, Xiao J, Boyacioglu D, Chen F, Capanoglu E. The Reciprocal Interactions between Polyphenols and Gut Microbiota and Effects on Bioaccessibility. Nutrients. 2016;8(2):78.

6. Konturek PC,Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. Journal of Physiology and Pharmacology. 2011;62(6):591-599.

According to National Health and Morbidity Survey (NHMS 2019), about 1.7 million individuals in Malaysia are at risk of suffering from 3Hs, namely hypertension, hyperlipidemia (high cholesterol) and hyperglycemia (diabetes) which leads to cardiovascular disease. It is well known that cardiovascular disease is the leading cause of death in Malaysia.

Plukenetia volubilis L. (family Euphorbiaceae), commonly known as Sacha Inchi, Inca peanut or mountain peanut has been adopted as a food source due to its high nutritional value and potential benefits for human health. Sacha Inchi is used as a traditional remedy and in recent years has been introduced to cosmetics and dietary supplementation markets successfully.

Content of Sacha Inchi

Medicinal applications of Sacha Inchi have been discussed for a variety of diseases. Besides its cholesterol and blood pressure lowering properties, it is presumed that Sacha Inchi may promotes health improvements in diabetic, arthritis, cancers (breast cancer, prostate carcinoma) and in certain cases of psychological disorders patients. Due to its recognized high content of essential fatty acids, phenolic compounds and vitamin E, Sacha Inchi provides antioxidant properties, hypolipidemic, immunomodulation and emollient activity, as well as capacity to remove heavy metals from aqueous solutions.

Sacha inchi has been known to be rich in unsaturated fatty acids. Its seed contains:

1. Polyunsaturated fatty acids like α-linolenic (ALA) and linoleic (LA), bases of ω-3 and -6, respectively, γ- and δ-tocopherols,
2. Natural forms of vitamin E, known for its antioxi­dant activity and antitumor potential.

Essential fatty acids in the form of omega 3 and omega 6 contained in sacha inchi oil are 50.5% and 34.1% respectively, while the protein content in Sacha Inchi is 22-30%. These biomolecules are involved in immune functions, where it helps in mediating inflamma­tory response. Intake of omega-3 fatty acids from other sources is widely used to lower high blood triglyceride levels which positively influence blood flow and blood clotting.  In this context, Sacha Inchi oil has been assumed to be an alternative to fish oil.

Studies on Sacha Inchi

Gonzales et al. conducted a study for four months on 15 males and 15 females without the history of hyperlipidaemia or any other disease likely to affect lipid me­tabolism showed that the permanent consumption of sacha inchi oil for four consecutive months showed 10 % increase in plasma HDL level. Other study also stated that consumption of 50 g of sacha inchi can significantly lower triglyceride levels. Although sacha inchi oil may have an unpleasant taste, it is believed that over time it can be accepted by consumers. Commercial sacha inchi oil is classified as extra virgin oil or virgin oil and has low oxidative stability thus should not be consumed hot.

Polyunsaturated fatty acids of Sacha Inchi is the main component that contributed to its beneficial function in variety of processes such as regulation of the inflammatory immune response, blood pres­sure, re­duction of triglyceride levels in the circulation, prevention of neurodegenerative and neuropsychiatric disorder, main­tenance of memory and visual function. Supplementation of yoghurt with sacha inchi seeds has been studied recently, revealing an increase of the levels of ALA and LA of 25- and 50-fold respectively, from an average PUFA content of 3.60 to 81.51% in the modified product compared to the control.

It is considered that fatty acids with higher fraction of PUFA in sacha inchi are beneficial to human health due to their antiatherogenic, antithrombogenic and hypocholester­olemic effects, besides having a high nutritional value.

Sources of sacha inci

Sources of sacha inchi can be varies in these modern days. Various brands has marketed sacha inchi in form of oil and softgels. Some people would simply enjoy sacha inchi by roasting the seed or mix with other nuts for snacking.

References

1. Cárdenas DM, Gómez Rave LJ, Soto JA. Biological Activity of Sacha Inchi (Plukenetia volubilis Linneo) and Potential Uses in Human Health: A Review. Food Technol Biotechnol. 2021 Sep;59(3):253-266.
2. Gonzales GF, Gonzales C. A randomized, double-blind pla­cebo-controlled study on acceptability, safety and efficacy of oral administration of sacha inchi oil (Plukenetia volubilis L.) in adult human subjects. Food Chem Toxicol. 2014;65: 168–76.
3. Hanssen, H.-P. and Schmitz-Hübsch, M. (2011) Nuts and Seeds in Health and Disease Prevention, Chapter 117 – Sacha Inchi (Plukenetia volubilis L.) Nut Oil and Its Therapeutic and Nutritional Uses. Academic Press. Available at: https://doi.org/10.1016/B978-0-12-375688-6.10117-3 (Accessed: April 14, 2023).

Confinement​​​ is a period to allow a mother to recuperate and recover after childbirth. The idea of confinement is familiar to Asians but foreign to Westerners. In the past when infant and maternal mortality rates were high, it was a practice to keep both the baby and mother indoors during the period of confinement to protect them from ill health. However, many of these practises originated from Asian culture and hence, possess no scientific basis at all.

Myth #1: I cannot drink plain water at all during confinement

Fact: Adequate fluid consumption is advised especially if the mother is breastfeeding. In case one drinks less water, it could be hazardous as it may lead to the formation of blood clots in your body. New mothers tend to sweat a lot, and they are also producing milk. It is therefore even more important for them to stay hydrated. The kidneys will produce more urine in the first few weeks after the baby is born to remove the excess fluid that has accumulated during the course of the pregnancy.​

Myth #2: I am not allowed to bathe or touch water for fear of ‘wi​​​nd’ entering the body

Fact: There is no basis to these beliefs. In fact, bathing regularly ensures good personal hygiene and comfort. It also reduces the chance of skin and wound infections.

Myth #3: I must not consume cold food (fruits and vegetables)

Fact: In fact, half of a recovering mother’s diet should consist of fruits and vegetables to help her restore important nutrients and source of fiber. Fiber is important to help avoid constipation among postpartum mothers and prevent hemorroids to happen.

Myth #4: I cannot eat chicken

Fact: It is important to have a well-balanced diet during confinement to replenish the body’s stores rather than avoiding specific food types. Other than consuming fibers, the other half diet portion of a postpartum mother should include whole grains such as brown rice and whole-grain bread. Overall, following the food pyramid is still the way to go. In the case of vegetarians or vegans, iron or vitamin supplements may be taken to fulfill these nutritional needs. However, there are some foods that you should avoid, such as raw food, caffeine and alcohol.

Myth #5: I have been told not to read or cry

Fact: According to traditional Chinese beliefs, childbirth is thought to weaken the liver which is linked to the eyes. During confinement, it is believed that mothers should not read or cry to avoid exerting stress on the eyes. However, there is no scientific proof to back up this belief. While prolonged reading of fine print may cause eye strain, there is no evidence to suggest that it can directly cause damage to the eyes. The same can be said for crying. In fact, crying can be a way of relieving stress and dealing with the emotions that come with being a new mum.

Myth #6: I must not expose myself and my baby to any wind drafts or air-conditioning

Fact: For personal comfort, there is definitely no harm in switching on the air-conditioner or fan, as long as it makes you and your baby comfortable. It may even help prevent heat rash from developing under hot and humid climate.

Myth #7: I shouldn’t walk or move about

Fact: While it’s true that mothers who have just given birth especially those who gave birth via C-section need to rest, they should not be restricted to just lying in bed. Experts recommend new mothers to walk and move around once they feel comfortable as it can help decrease the risk of blood clots (deep vein thrombosis).

Postpartum care

Get plenty of rest
Get as much sleep as possible to cope with tiredness and fatigue. Your baby may wake up every two to three hours for feeding. It is advised that postpartum mothers should get enough rest, sleep when your baby sleeps.

Eat healthy meals
Eat healthy diet to promote healing. Increase your intake of whole grains, vegetables, fruits, and protein. You should also increase your fluid intake, especially if you are breast-feeding.

Seek help
Don’t hesitate to accept help from family and friends during the postpartum period, as well as after this period. Your body needs to heal, and practical help around the house hold can help you get much-needed rest. Friends or family can prepare meals, run errands, or help care for other children in the house hold.

Exercise
Your doctor will let you know when it’s OK to exercise. The activity should not be strenuous. Try taking a walk near your house. The change of scenery is refreshing and can increase your energy level.

References:

8 Confinement Myths Debunked [Internet]. Gleneagles Hospital. [cited 2023 Apr 19]. Available from: https://www.gleneagles.com.sg/healthplus/article/confinement-myths-debunked
Confinement After Pregnancy: 12 Myths and Facts – HealthXchange [Internet]. [cited 2023 Apr 19]. Available from: https://www.healthxchange.sg:443/women/post-pregnancy/confinement-after-pregnancy-myths-facts
Confinement Food in Chinese, Malay and Indian Cultures – HealthXchange [Internet]. [cited 2023 Apr 19]. Available from: https://www.healthxchange.sg:443/women/post-pregnancy/confinement-food-chinese-malay-indian
Myths About Postpartum Care – Healthcare Wellness Blogs – Ovum Hospital [Internet]. 2022 [cited 2023 Apr 19]. Available from: https://ovumhospitals.com/blog/myths-about-postpartum-care/
Confinement Practices and Myths: Part 1 [Internet]. [cited 2023 Apr 19]. Available from: https://www.healthhub.sg/live-healthy/1068/pregnancy-confinement-practices-and-myths
Postpartum Care: Tips for the Recovery Process [Internet]. Healthline. 2016 [cited 2023 Apr 19]. Available from: https://www.healthline.com/health/postpartum-care

What is nappy rash?

Nappy rash is a skin irritation around the area covered by the baby’s nappy. It can look like a mild pink or red rash just covering some of their skin, or across their whole nappy area. If left untreated, nappy rash can develop blisters and even open sores.

Some babies have skin conditions that make them particularly sensitive. Eczema, psoriasis and impetigo can make nappy rash worse because of a breakdown in the skin.

Nappy rash will affect 1 in 3 babies before the age of 2. There are things we can do to help avoid these rashes and to treat them if and when they do occur. 

Signs and symptoms of nappy rash

The skin on the child’s bottom and genitals will look inflamed and sore. On children with darker skin, the inflammation might look brown, purple or grey. On children with lighter skin, the inflammation might look red. Some areas of skin might be raised or swollen, and there might be breaks in the skin. These breaks are called ulcers. Skin folds aren’t usually affected because wee doesn’t get into them. But nappy rash might sometimes go up onto the child’s tummy or spread up towards the baby’s back.

The rash can be uncomfortable and even painful, which can make the child irritable.

4types of nappy rash

1. BACTERIAL 

Most rashes are an irritation of the skin caused or aggravated by contact with the wee and poo. The rash starts with a slight reddening of the skin in the nappy area and can progress to soreness and discomfort.

• The most common type of nappy rash is a mild bacterial rash.
• The skin looks red and sore and can almost appear shiny.
• This is usually caused when the baby’s bottom is in contact with a wet or dirty nappy for a long period of time.
• A normal disposable nappy is made of plastic and traps heat and moisture inside. This combined with the wee or poo, makes a perfect breeding ground for bacteria.

2. FRICTION 

Nappy rash can be caused by chaffing or rubbing if skin is very sensitive or the nappy is the wrong size.

• A common cause of nappy rash is friction caused by the nappy rubbing against the baby’s delicate skin.
• Whether the parents use disposables or reusable do check the fit of the nappy.
• It should be snug around the tummy but not too tight – parents should be able to fit their finger inside the waist band.
• The tabs should come around the sides and sit on the frontal sticky tape without having to cross over or meet – Most brands have a logo on their tape. Parents should sit be able to see this once the nappy is fastened.
• The leg ruching should not leave deep red indents in the babies’ skin. If it does, it is too tight.
• Conversely a too loose nappy can cause chafing between the thighs.
• Check the size chart on the nappies but remember every baby is different, so it may be a case of using the parents’ intuition. 

3. FUNGAL

A bright red, moist rash with white or red pimples which spreads to the folds of the skin, may indicate that the baby has a thrush infection and requires a prescribed cream.

• This kind of rash can sometimes happen if the baby is on antibiotics or if they have thrush.
• A fungal rash shows as tiny red spots and the genitals can appear slightly swollen.
• This needs to be treated using an anti-fungal cream, available on prescription from the GP.
• This should be applied thinly to the affected area.
• If the nappy rash is fungal it is important that we avoid our usual barrier cream as this can make the condition worse.

4. ALLERGY 

Occasionally nappy rash can become persistent and can be related to other skin conditions like eczema or allergies.

Some babies have sensitivities or allergies to the various components of their nappies or wet wipes.

Normal nappies are made using:

• Polypropylene     
• Polyester
• Polyethylene
• Latex or PVC
• Chlorine bleached pulp
• Adhesives
• Dyes
• Perfumes
• Lotions

Prevention of baby’s nappy rash

Prevention is always better than treatment.

Parents can reduce the chance of their child getting nappy rash by keeping their nappy area clean and dry. Change the child’s nappy frequently and give their bottom air as often as we can. Parents also can :

• use good quality, disposable nappies
• try to leave the baby’s nappy off whenever possible. This will keep the baby’s skin dry and away from any contact with wee or poo. Try laying the baby on a towel during tummy time or any floor play. Parents should always watch that they have not wet or soiled the towel so that they are not left on a damp towel
• only use warm water to clean the rash area
• avoid soaps and perfumed baby wipes as these can irritate the skin
• use soft towels or cotton wool when drying the skin, and dab the area gently
• apply a barrier cream after changing every nappy. Products containing zinc cream, zinc oxide ointment and petroleum jelly are all suitable. You can also ask your pharmacist about nappy rash creams
• do not use talcum powder or antiseptics

When should the parents or caretaker see a doctor?

See a doctor if:

• the rash doesn’t clear up in one week
• there are blisters, crusts or pimples
• the baby has a fever
• the rash is spreading
• the baby is very upset
• if the parents have a son, the end of his penis is red and swollen or has a scab

The doctor or pharmacist may need to give patients a medicated cream to treat the nappy rash. If it is caused by eczema or a skin infection, the doctor will need to give the patients the right treatment.

References

1. https://www.johnsonsbabyarabia.com/en/nappy-rash
2. https://raisingchildren.net.au/newborns/health-daily-care/poos-wees-nappies/nappy-rash
3. https://www.healthdirect.gov.au/nappy-rash
4. https://www.pregnancybirthbaby.org.au/nappy-rash#what
5. https://www.mamabamboo.com/blogs/news/nappy-rash

In this era of globalization, most people make caffeine their loyal company day in, day out to stay alert while working. Caffeine is also well-known among adolescents and young adults to burn the midnight oil or during their café hunting endeavors.

WHAT IS CAFFEINE?

Caffeine is a natural stimulant that is widely consumed all over the world. It mainly stimulates  our brain by blocking the effects of neurotransmitter adenosine that cause sleepiness and fatigue. As a result, it helps us to stay awake and prevent exhaustion.

Caffeine is usually found in plants including tea leaves and cocoa beans. There are also synthetically formed caffeine that has been added in some food, drinks, tablets  and supplements. Therefore, try to avoid these caffeinated foods and drinks six hours prior to sleep to prevent trouble sleeping.

As we all know, consumption of caffeine has often been related to sleep problems, increased case of heart palpitations and anxiety. Nonetheless, research found that it also has various health benefits.

BENEFITS OF CAFFEINE

·         Improves alertness and psychological health

A study reported that caffeine may improve alertness and decrease fatigue. Besides, caffeine has been linked to decrease risk of depression and suicide (Walter, 2022).

·         Boost metabolism and burn fat

Due to caffeine’s ability to stimulate the central nervous system, it may aid in boosting metabolism and promote fat burning. However, these effects are likely to remain small over the long term (Tabrizi et al. 2019). Another study also found that caffeine may decrease appetite which can slightly help in reducing weight gain (Walter, 2022).

·         Enhance exercise performance

It is reported that small amount of caffeine consumed before exercise can possibly show an acute increase in exercise performance (Diaz-Lara et al. 2022).

·         Reduced risk of chronic illnesses

Several studies reported that regular consumption of caffeine may decrease the risk of developing type 2 diabetes, endometrial cancer, liver cancer, gall-stones and gall-bladder cancers (Walter, 2022).

Note: The health benefits of caffeine are influenced by the amount of caffeine intake and physical condition of the consumer as well.

SIDE EFFECTS OF CAFFEINE

Excess consumption of caffeine is substantially associated with various side effects on our health.

Caffeine may also interact with calcium and iron absorption that may lead to calcium and iron deficiency. Besides, it can interact with some medications causing it to limit the effectiveness of certain medications. Thus, medications and caffeinated food and drinks should be taken separately.

Note: Caffeine affects individual differently. Some individual may experience the symptoms above with a small intake of caffeine within short period of time and vice versa.

RECOMMENDED DOSAGE

It is considered safe for healthy adults to consume 400 mg of caffeine a day (FDA 2018).

As for pregnant women, you are advised to limit your caffeine intake (≤ 200 mg per day) as it can easily cross the placenta which results in increased risk of miscarriage  and low birth weight.

A moderate amount of caffeine for Individual A may feel like a high dose for Individual B. In conclusion, every individual has different caffeine tolerance.

THE TAKEAWAY

Moderation is the key. Consume caffeine in moderation (≤400mg caffeine per day) so that you can enjoy the health benefits of caffeine without incurring it negative impact. You may also consider other ways to stay energized throughout the day by getting 7-8 hours of sleep per night and exercise regularly. If you have trouble staying awake and frequently feel tired, consult a doctor/physician for further assistance.

REFERENCES

Diaz-Lara, J., Grgic, J., Detanico, D., Botella, J., Jiménez, S. L. & Del Coso, J. 2022. Effects of acute caffeine intake on combat sports performance: A systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition: 1-16.

FDA. 2018. How much caffeine is too much? https://www.fda.gov/consumers- updates/spilling-beans-how-much-caffeine-too-much [3 May 2023].

Saimaiti, A., Zhou, D.D., Li, J., Xiong, R.G., Gan, R.Y., Huang, S.Y., Shang, A., Zhao, C.N., Li, H.Y. & Li, H.B. 2022. Dietary sources, health benefits, and risks of caffeine. Critical Reviews in Food Science and Nutrition: 1-19.

Saleem, A. R., Iftikhar, R., Kazmi, S. M. A. & Majeed, A. 2022. Effects of caffeine on mood, memory and attention. Pakistan Journal of Medical & Health Sciences 16(10): 541- 541.

Tabrizi, R., Saneei, P., Lankarani, K. B., Akbari, M., Kolahdooz, F., Esmaillzadeh, A., Nadi- Ravandi, S., Mazoochi, M. & Asemi, Z. 2019. The effects of caffeine intake on weight loss: a systematic review and dos-response meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition 59(16): 2688-2696.

Walter, K. 2022. Caffeine and health. JAMA 327(7): 693-693.

What exactly is a stretch mark?

A stretch mark is a type of scar that develops when our skin stretches or shrinks quickly. The abrupt change causes the collagen and elastin, which support our skin, to rupture. As the skin heals, stretch marks may appear. (1)
They’re common during puberty or pregnancy, in which they usually form during the last trimester. (2) The indented streaks (stretch marks) normally appear on the abdomen, breasts, hips, buttocks, thighs or other places on the body.(3) Stretch marks may also be influenced by the hormonal changes associated with puberty, pregnancy, bodybuilding, or hormone replacement therapy.(2)
Over time stretch marks may diminish, but will not disappear completely.(2) They aren’t painful or harmful, but some people don’t like the way they make their skin look.

How stretch mark looks like?

Stretch marks don’t all look alike. They vary depending on how long you’ve had them, what caused them, where they are on your body and the type of skin you have.(3)
When stretch marks first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on your skin color. Early stretch marks may feel slightly raised and can be itchy.
In time, the color fades and the narrow bands sink beneath your skin. If you run your finger over a mature stretch mark, you often feel a slight depression.(1)

Who are more prone to getting stretch marks?

Anyone can develop stretch marks, but some factors increase your likelihood of getting them, including:

• Being female
• Having a personal or family history of stretch marks
• Being pregnant, especially if you’re young
• Rapid growth in adolescence
• Rapidly gaining or losing weight
• Using corticosteroids
• Having breast enlargement surgery
• Exercising and using anabolic steroids
• Having a genetic disorder such as Cushing’s syndrome or Marfan syndrome(3)

How to treat stretch marks?

Stretch marks are harmless and often fade over time. Treatment can make them fade, but they may never completely disappear.
The following treatments are among those available to help improve the appearance and texture of stretch marks. None has been proved to be more consistently successful than the others.

1. Retinoid cream. Derived from vitamin A, retinoids — such as tretinoin (Retin-A, Renova, Avita) — that you apply to your skin may improve the appearance of stretch marks less than a few months old. Tretinoin, when it works, helps to rebuild a protein in the skin called collagen, making the stretch marks look more like your normal skin. Tretinoin can irritate your skin.
   If you’re pregnant or nursing, talk with your doctor about other treatment options, because possible side effects of retinoid cream may affect the baby.
2. Light and laser therapies. A variety of light and laser therapies are available that might stimulate growth of collagen or promote elasticity. Your doctor can help you determine which technique is appropriate for you.
3. Microneedling. This type of treatment involves a hand-held device with tiny needles that stimulate collagen growth. This technique has less risk of pigmentation changes than does laser therapy so is the preferred initial approach for people with darker skin.(3)
4. Stretch mark creams, lotions, and gels. Researchers have studied many of the creams, lotions, and gels sold to treat stretch marks. While no one product seems to help all of the time — and some don’t seem to help at all — researchers have discovered some helpful hacks.
   If you want to try one of these creams, lotions, or gels to fade stretch marks, be sure to use the product on early stretch marks. Treatment seems to have little effect on mature stretch marks. You should massage the product into your stretch marks. Taking time to massage the product gently into your skin may make it more effective. Applying the product every day for weeks may also increase effectiveness of the products. If you see results, they take weeks to appear.(1)

Work with your doctor to choose the most appropriate treatment or combination of treatments for you. Factors to consider include:

• How long you’ve had the stretch marks
• Your skin type
• Convenience, as some therapies require repeated doctor visits
• Cost
• Your expectations

How to prevent formation of a stretch mark?

Collagen and elastin are proteins in the skin that contribute to the skin’s strength, resilience, flexibility, and help skin that has been stretched to recover to its original state. Boosting the production of collagen and elastin helps prevent stretch marks from occurring.Stretch marks can also derive from nutritional deficiencies. Consuming foods that contribute to the skin’s health, such as zinc-rich foods, foods high in vitamin A, C, D, and protein rich foods, can help suppress stretch marks. (4)

References

1. Stretch marks: Why they appear and how to get rid of them. (n.d.). https://www.aad.org/public/cosmetic/scars-stretch-marks/stretch-marks-why-appear
2. Wikipedia contributors. (2022, December 22). Stretch marks. Wikipedia. https://en.wikipedia.org/wiki/Stretch_marks
3. Stretch marks – Symptoms and causes. (2022, August 23). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/stretch-marks/symptoms-causes/syc-20351139
4. Skin: Layers, Structure and Function. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/10978-skin

INTRODUCTION

Diabetic foot is one of the most devastating complications of diabetes, which is defined as infection, ulceration or destruction of tissues at the foot. It is usually the result of poor glycemic control, underlying nerve damage, peripheral vascular disease, or poor foot care.

According to World Health Organization, the global prevalence of diabetes among adults of > 18 years old has risen from 4.8% in 1980 to 8.5% in the year of 2014. As the numbers of newly diagnosed diabetics increase yearly, the incidences of foot ulcer also increase.

ETIOLOGY

The etiology of diabetic foot ulcer is multifactorial, however the common underlying causes are:

1. Poor blood sugar control
2. Formation of calluses
3. Foot deformities
4. Improper foot care
5. Underlying nerve damage / poor blood circulation of lower limbs
6. Dry skin

PRESENTATION OF THE WOUND

1. Well defined wound
2. Punch out-look
3. Surrounding skin will often be calloused
4. Depth of wound typically depending on the thickness of callous

The most common cause of ulceration is due to repetitive mechanical forces of gait, which lead to callus (pre-ulcerative lesion). When the callus becomes too thick, the callus will press on the soft tissues underneath which eventually lead to ulceration.

A layer of whitish, macerated, moist tissue found under the surface of the callus indicates that the foot is close to ulceration, and urgent removal of the callus is necessary.

Figure 1 showing diabetic ulcer revealed underneath of callus.

TREATMENT

PHARMACOLOGICAL TREATMENT

Oral Analgesic

Simple pain killer ( e.g. paracetamol or NSAIDs) should be considered in mild and moderate pain in diabetic foot ulcer patient.

• Topical antibiotic

Topical antibiotics are used to treat infected wound or to further prevent infection in uninfected wound.

• Oral Antibiotic

Oral antibiotic will be prescribed by physician when there are systemic symptoms of infection in diabetic foot ulcer patient.

NON PHARMACOLOGICAL TREATMENT

Wound care

Wound care is important in management of diabetic foot. There are different types of wound dressing which helps in reduce symptom, provide wound protection and improve wound healing. It has 3 important steps in diabetic wound management:

1. Debridement

Debridement is a process of removing debris and surrounding callus that will slow down wound healing and causes infection.

• Offloading

Offloading is the process of redistribution the pressure off the wound to the entire weight-bearing surface of the foot. It can be achieved by either wearing temporary footwear until ulcer heal or wearing pressure-relief devices

Mechanical loading of feet during daily activities, e.g. walking or standing which exposes pressure on plantar surface causing compression and shear stress. This pressure and stress will be aggravated by foot deformities ( e.g. hammer and claw toes) which are very common in diabetic patients. Therefore patients are advised on using footwear that fits, protects and accommodates the shape of feet (with socks). Patient who are at moderate or high-risk are usually prescribed with footwear with removable cast boots to decrease the pressure on affected area. It has to ensure that it fits, protects and supports the foot.

c. Appropriate wound dressing

• Dry wound needs topical application that add moisture to the wound
• Diabetic wound with heavy exudates needs a dressing to absorb moisture.
• Dressings need to be changed at least daily in order to apply clean wound covering & monitor infected wound.

Vitamin B12

Vitamin B12, which is also known as cobalamin is vital for proper functioning and development of nervous system. Nerve damage with symptoms of pain, tingling, numbness and loss of sensation is often associated with Vitamin B12 deficiency.

Metformin, which is one of the diabetic agent commonly used for diabetic patient has confirmed that its long term use has contributed to vitamin B12 deficiency in patient with diabetic disease. Metformin has been reported to lead to malabsorption of vitamin B12. Therefore, diabetic patient who is taking metformin is encouraged to consume vitamin B12 through diet or supplement. This is to prevent development of nerve damage which eventually leads to foot ulcer.

PREVENTION

Patients who are at high risk of developing diabetic foot ulcer need to know the basic care of foot, callus and nail, this should be done regularly to prevent foot problems. Diabetic foot prevention can be done by:

• Lifestyle modification
  • Having good glycemic and blood pressure control by taking medication, follow diet plan, exercise regularly, and monitor blood sugar regularly through HbA1c test is important to reduce the incidence of diabetic foot ulcer and subsequent risk of amputation.
• Smoke cessation
  • Do not smoke as it reduce blood flow in feet.
• Take good care of feet hygiene by washing them daily with mild soap. Use only lukewarm (below 37°C) and not hot water. Do not soak feet as it can cause dry skin.
• Use moisturizer daily to keep dry skin from itching or cracking. But do not moisturize between the toes as it could risk an infection to occur
• Cut toenails carefully after washing and drying the feet. Do not cut nails too short as this could lead to ingrown toenails.

• No self-treat corns or calluses.
• Wear clean and dry socks which are not too tight and are light coloured. Socks with extra cushioning, no elastic top, higher than ankle, made from fibers material are preferred.
• Never walk barefoot indoors or outdoors.
• Put feet up when sitting to ensure good blood circulation. Keep the blood flowing to feet by wiggling toes and moving ankles for five minutes, 2 – 3 times a day. Don’t cross legs for long periods of time.
• Seek for treatment if there is presence of pain, noticeably red or discolored areas, discharge, bad smell, ulcer, blister or if feeling generally unwell with difficulty controlling blood sugar level

REFERENCE

1. Ministry of Health Malaysia. Clinical practice guideline: Management of diabetic foot. 2nd ed. Ministry of Health Malaysia. http://www.moh.gov.my/. 2018.
2. Edmonds ME, Foster AV. ABC of wound healing: Diabetic foot ulcers. BMJ. 2006 May 1;332(Suppl S5).
3. MIMS Malaysia. Infectious Disease: Diabetic Foot Infection. https://specialty.mims.com/diabetic%20foot%20infection/signs%20and%20symptoms?channel=infectious-diseases.
4. Badedi M, Darraj H, Hummadi A, Solan Y, Zakri I, Khawaji A, Daghreeri M, Budaydi A. Vitamin b12 deficiency and foot ulcers in type 2 diabetes mellitus: A case–control study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2019 Dec 6:2589-96.